bulneur1_08

Å˙Î„‡ÒÍ‡ çÂ‚ÓÎÓ„ËflBulgarian Neurology

ë‰ÛÊÂÌËÂ ◊Å˙Î„‡ÒÍÓ ‰ÛÊÂÒÚ‚Ó ÔÓ ÌÂ‚ÓÎÓ„Ëfl“Official Journal of The Bulgarian Society of Neurology

íéå 8 / Åêéâ 1åÄêí, 2008

VOLUME 8 / NUMBER 1MARCH, 2008

ëöÑöêÜÄçàÖ

éÅáéêà

èéãàçÖÇêéèÄíàü à åàéèÄíàü èêà äêàíàóçàëöëíéüçàüå. åËÎ‡ÌÓ‚‡, Ñ. ÄÚ‡Ì‡ÒÓ‚‡, ç. åÛ‡‰flÌ, å. ê‡‰Â‚‡ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

ÑÖäéåèêÖëàÇçÄ äêÄçàéíéåàü èêà ãÖóÖçàÖ çÄ åÄãàÉçÖç åéáöóÖç àçîÄêäíÖ. Ç‡‚ÂÍ, ë. àÒ‡ÍÓ‚, Ñ. ÄÚ‡Ì‡ÒÓ‚‡, å. åËÎ‡ÌÓ‚‡ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

éêàÉàçÄãçà ëíÄíàà

AXURA áÄ ãÖóÖçàÖ çÄ ìåÖêÖçÄ äöå íÖÜäÄ îéêåÄ çÄ ÅéãÖëííÄ çÄ ÄãñïÄâåÖê. éí ÖäëèÖêàåÖçíÄ äöå äãàçàóçÄíÄ èêÄäíàäÄëÚ. üÌ˜Â‚‡ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

ÖèàãÖèëàü à åéáöóçà äÄÇÖêçéåàê. èÓÔÓ‚, ü. ÖÌ˜Â‚, ä. åËÌÍËÌ, Ç. ÅÛÒ‡ÒÍË, ä. êÓÏ‡ÌÒÍË, å. ÇËÍÚÓÓ‚‡ . . . . . . . . . . . . . . . . . . . . . . .12

ÑÇàÉÄíÖãçÄ àçÇÄãàÑàáÄñàü, äéÉçàíàÇçà à ÖåéñàéçÄãçà çÄêìòÖçàü èêà Åéãçà ë èÄêäàçëéçéÇÄ ÅéãÖëíÑ. ïËÒÚÓ‚‡, á. á‡ı‡ËÂ‚, à. ÉÓÁ‰Â‚ . . . . . . . . . . . . . . .15

ASPECTS - áçÄóÖçàÖ çÄ êÄççàíÖ äí ÅÖãÖáà èêà Åéãçà ë àëïÖåàóÖç åéáöóÖçàçëìãí Ç ÅÄëÖâçÄ çÄ ëêÖÑçÄ åéáöóçÄ ÄêíÖêàüÖ. Ç‡‚ÂÍ, å. äÎËÒÛÒÍË . . . . . . . . . . . . . . . . . . . . . . . . . .20

HIP-SPINE ëàçÑêéå èêÖÑà à ëãÖÑ ÖçÑéèêéíÖáàêÄçÖ çÄ íÄáéÅÖÑêÖçÄ ëíÄÇÄè. ÄÚ‡Ì‡ÒÓ‚‡, Ä. ÄÚ‡Ì‡ÒÓ‚, ç. í‡ÈÍÓ‚‡,å. ëÂÏÂ‰ÊËÂ‚‡, à. äÓÎÂ‚‡ . . . . . . . . . . . . . . . . . . . . . . .24

CONTENTS

REVIEWS

CRITICAL ILLNESS POLYNEUROPATHY AND MYOPATHYM. Milanova, D. Atanasova, N. Muradyan, M. Radeva . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

TREATMENT OF PATIENTS WITH MALIGNANT STROKEWITH DECOMPRESSIVE CRANIAL SURGERYE. Vavrek, S. Isakov, D. Atanasova, M. Milanova . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

ORIGINAL PAPERS

AXURA IN THE TREATMENT OF MODERATE TO SEVERE ALZHEIMER’S DISEASE

St. Yancheva . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

BRAIN CAVERNOMAS AND EPILEPSYR. Popov, Y. Enchev, K. Minkin, V. Bussarsky, K. Romansky, M. Viktorova . . . . . . . . . . . . . . . . . . . . . . . . .12

LOCOMOTORIAL INCAPACITATION, COGNITIVE AND EMOTIONAL IMPAIRMENT IN PARKINSON’S DISEASE PATIENTS.D. Hristova, Z. Zahariev, I. Grozdev . . . . . . . . . . . . . . . . .15

ASPECTS – THE ROLE OF EARLY CT SIGNS IN PATIENTS WITH ACUTE MIDDLE CEREBRAL ARTERY ISCHEMIC STROKEE. Vavrek, M. Klissurski . . . . . . . . . . . . . . . . . . . . . . . . . . .20

HIP-SPINE SYNDROME BEFORE AND AFTER TOTAL HIP REPLACEMENTP. Atanassova, A. Atanassov, N. Traykova, M. Semerdjieva, I. Koleva . . . . . . . . . . . . . . . . . . . . . . . . . .24

ISSN 1311-8641

Å˙Î„‡ÒÍ‡ çÂ‚ÓÎÓ„ËflBulgarian Neurology

ë‰ÛÊÂÌËÂ ◊Å˙Î„‡ÒÍÓ ‰ÛÊÂÒÚ‚Ó ÔÓ ÌÂ‚ÓÎÓ„Ëfl“Official Journal of The Bulgarian Society of Neurology

êÖÑÄäñàéççÄ äéãÖÉàü

ÄÎÂÍÒËÂ‚ Ä. ëÓÙËfl

Å‡Î‰‡‡ÌÓ‚ Ñ. ëÓÙËfl

ÅÓÊËÌÓ‚ ëÚ. èÎÂ‚ÂÌ

ÅÓÊËÌÓ‚‡ Ç ëÓÙËfl

Ç‡ÒËÎÂ‚‡ Ö. ëÓÙËfl

Ç‡ÒËÎÂ‚‡ í. èÎÓ‚‰Ë‚

É‡ÌÂ‚‡ É. ëÓÙËfl

ÉÂÓ„ËÂ‚ Ñ. ëÓÙËfl

ÉÂ‡ÒËÏÓ‚ Å. ëÓÙËfl

ÉÓÁÏ‡ÌÓ‚ É. èÎÓ‚‰Ë‚

ÉË„ÓÓ‚‡ é. ëÓÙËfl

ÑÂÎÂ‚‡ ç. Ç‡Ì‡

á‡ı‡ËÂ‚ á. èÎÓ‚‰Ë‚

äÓÎÂ‚ é. ëÓÙËfl

äÓÎÂ‚ è. ëÓÙËfl

å‡Ì˜Â‚ à. ëÚ.á‡„Ó‡

å‡ÒÎ‡Ó‚ Ñ. ëÓÙËfl

åËÎ‡ÌÓ‚ à. ëÓÙËfl

åËÎ‡ÌÓ‚‡ å. ëÓÙËfl

åËÌ˜Â‚ Ñ. Ç‡Ì‡

èÂÚÓ‚ à. ëÓÙËfl

èÂÚÓ‚‡ û. ëÓÙËfl

ê‡È˜Â‚ à. ëÓÙËfl

ê‡È˜Â‚‡ å. ëÓÙËfl

ëÚ‡ÏÂÌÓ‚ Å. èÎÂ‚ÂÌ

íËÚflÌÓ‚‡ Ö. ëÓÙËfl

í‡ÈÍÓ‚ ã. ëÓÙËfl

í˙ÌÂ‚ à. ëÓÙËfl

ï‡‚ÂÁÓ‚‡ ã. Ç‡Ì‡

ï‡‡Î‡ÌÓ‚ ã. ëÓÙËfl

ó‡Î˙ÍÓ‚‡ ç. èÎÓ‚‰Ë‚

óÂÌËÌÍÓ‚‡ ë. ëÓÙËfl

òÓÚÂÍÓ‚ è. ëÓÙËfl

üÌ˜Â‚‡ ë. ëÓÙËfl

EDITORS

Alexiev A. Sofia

Baldaranov D. Sofia

Bojinov St. Pleven

Bojinoba V. Sofia

Vassileva E. Sofia

Vassileva T. Plovdiv

Ganeva G. Sofia

Georgiev D. Sofia

Gerassimov B. Sofia

Gozmanov G. Plovdiv

Grigorova O. Sofia

Deleva N. Varna

Zahariev Z. Plovdiv

Kolev O. Sofia

Kolev P. Sofia

Manchev I. St. Zagora

Maslarov D. Sofia

Milanov I. Sofia

Milanova M. Sofia

Minchev D. Varna

Petrov I. Sofia

Petrova U. Sofia

Raychev I. Sofia

Raycheva M. Sofia

Stamenov B. Pleven

Titianova E. Sofia

Traykov L. Sofia

Tarnev I. Sofia

Havezova L. Varna

Haralanov L. Sofia

Chalakova N. Plovdiv

Charninkova S. Sofia

Shotekov P. Sofia

Yancheva S. Sofia

Publ

ishe

r Col

or S

tudi

o®

ÉãÄÇçà êÖÑÄäíéêà: à. åËÎ‡ÌÓ‚, è. ëÚ‡ÏÂÌÓ‚‡, à. ÇÂÎ˜Â‚‡

ëÖäêÖíÄê:å. Ñ‡ÒÍ‡ÎÓ‚

EDITOR IN CHIEF:I. Milanov, P. Stamenova, I. Velcheva

SECRETARY:M. Daskalov

ìäÄáÄçàÖ áÄ ÄÇíéêàíÖ

Å˙Î„‡ÒÍ‡ çÂ‚ÓÎÓ„Ëfl Â ÓÙËˆË‡ÎÂÌ Ó„‡Ì Ì‡ ë‰ÛÊÂÌËÂ

◊Å˙Î„‡ÒÍÓ ‰ÛÊÂÒÚ‚Ó ÔÓ ÌÂ‚ÓÎÓ„Ëfl“ Ë ÔÛ·ÎËÍÛ‚‡ ÒÚ‡ÚËË ÓÚ ‚ÒË˜ÍË

Ó·Î‡ÒÚË Ì‡ ÌÂ‚ÓÎÓ„ËflÚ‡. ëÔËÒ‡ÌËÂÚÓ Ò˙‰˙Ê‡ ÒÎÂ‰ÌËÚÂ Û·ËÍË:

-êÂ‰‡ÍˆËÓÌÌ‡ ÒÚ‡ÚËfl Ò ÚÂÍÒÚ ‰Ó3 ÒÚ‡ÌËˆË. Ç˙ÁÎ‡„‡ ÒÂ ÓÚ

êÂ‰ÍÓÎÂ„ËflÚ‡.

-éË„ËÌ‡ÎÌË ÒÚ‡ÚËË - ‰Ó 8 ÒÚ‡ÌËˆË, ‚ÍÎ˛˜ËÚÂÎÌÓ Ú‡·ÎËˆË,

ÙË„ÛË, ÍÌË„ÓÔËÒ. ä˙Ï ÚÂÁË ÒÚ‡ÚËË ÒÂ ËÁËÒÍ‚‡ ÂÁ˛ÏÂ Ì‡ ·˙Î„‡Ò-

ÍË Ë ‡Ì„ÎËÈÒÍË ÂÁËÍ Ó·˘Ó ‰Ó 40 Â‰‡, ÓÚÔÂ˜‡Ú‡ÌË Ì‡ ÓÚ‰ÂÎÌË ÒÚ‡-

ÌËˆË.

êÂÁ˛ÏÂÚÓ Úfl·‚‡ ‰‡ Ò˙‰˙Ê‡ Á‡„Î‡‚ËÂ, ËÏÂÌ‡Ú‡ Ì‡ ‡‚ÚÓË-

ÚÂ, ËÌÙÓÏ‡ˆËfl Á‡ ˆÂÎÚ‡ Ë Ó·ÂÍÚ‡ Ì‡ ÔÓÛ˜‚‡ÌÂÚÓ, ÏÂÚÓ‰ËÍËÚÂ,

ÔÓÎÛ˜ÂÌËÚÂ ÂÁÛÎÚ‡ÚË. èÓÒÓ˜‚‡Ú ÒÂ ‰Ó 6 ÍÎ˛˜Ó‚Ë ‰ÛÏË.

éË„ËÌ‡ÎÌËÚÂ ÒÚ‡ÚËË ‚ÍÎ˛˜‚‡Ú Í‡Ú˙Í Û‚Ó‰, ÍÓÌÚËÌ„ÂÌÚ,

ÏÂÚÓ‰Ë, ÂÁÛÎÚ‡ÚË, Ó·Ò˙Ê‰‡ÌÂ Ë ÍÌË„ÓÔËÒ.

á‡„Î‡‚Ì‡Ú‡ ÒÚ‡ÌËˆ‡ Ò˙‰˙Ê‡ Ô˙ÎÌÓ Ë Ò˙Í‡ÚÂÌÓ Á‡„Î‡‚ËÂ,

ËÏÂÌ‡Ú‡ Ì‡ ‡‚ÚÓËÚÂ Ò ËÌËˆË‡ÎËÚÂ ËÏ, ÚÂıÌËÚÂ ‡Í‡‰ÂÏË˜ÌË ÒÚÂ-

ÔÂÌË Ë ÏÂÒÚÓ‡·ÓÚ‡, ‡‰ÂÒ Á‡ ÍÓÂÒÔÓÌ‰ÂÌˆËfl Ò ÚÂÎÂÙÓÌ, Ù‡ÍÒ Ë Â-

mail.

-ä‡ÚÍË Ì‡Û˜ÌË Ò˙Ó·˘ÂÌËfl ‰Ó 3 ÒÚ‡ÌËˆË

-é·ÁÓÌË ÒÚ‡ÚËË ‰Ó 10 ÒÚ‡ÌËˆË

-àÌÙÓÏ‡ˆËË Ë ÂˆÂÌÁËË Ì‡ ÍÌË„Ë . ë˙‰˙Ê‡ ËÌÙÓÏ‡ˆËfl Á‡

ÍÓÌ„ÂÒË Ë ÍÓÌÙÂÂÌˆËË, ÌÓ‚Ë ÍÌË„Ë, ‡ÍÚÛ‡ÎÌ‡ ÎÂÍ‡ÒÚ‚ÂÌ‡ ËÌÙÓ-

Ï‡ˆËfl , ÔÂ‰ÒÚÓfl˘Ë Ò˙·ËÚËfl.

-ëÚ‡ÌËˆË Ì‡ ˜ËÚ‡ÚÂÎfl. èÓÏÂÒÚ‚‡Ú ÒÂ ÔËÒÏ‡ ‰Ó Â‰‡ÍÚÓ‡,

‚ ÍÓËÚÓ ÒÂ ÍÓÏÂÌÚË‡Ú ÔÛ·ÎËÍÛ‚‡ÌË Ï‡ÚÂË‡ÎË, Í‡ÚÍË ÓÔËÒ‡ÌËfl

Ì‡ ÒÎÛ˜‡Ë Ë ‰ËÒÍÛÒËË ÔÓ ‡ÍÚÛ‡ÎÌË ÔÓ·ÎÂÏË .

ëÚ‡ÚËËÚÂ Úfl·‚‡ ‰‡ ·˙‰‡Ú ÔÂ‰ÒÚ‡‚ÂÌË Ì‡ ‰ËÒÍÂÚ‡, Á‡ÔËÒ‡-

ÌË Ì‡ Â‰‡ÍÚÓÒÍ‡ ÔÓ„‡Ï‡

Word 6/Windows 96 ËÎË Word 7/ Windows 98, Ò Â‰ËÌ ÂÍÁÂÏÔÎfl

‡ÁÔÂ˜‡ÚÍ‡

í‡·ÎËˆËÚÂ ÒÂ ÔÂ‰ÒÚ‡‚flÚ Ì‡ ÓÚ‰ÂÎÂÌ ÎËÒÚ, ÌÓÏÂË‡ÌË, Í‡-

ÚÓ ‚ ÚÂÍÒÚ‡ ÒÂ ÓÚ·ÂÎÂÊË ÏflÒÚÓÚÓ ËÏ. í‡·ÎËˆËÚÂ ‰‡ ËÏ‡Ú Í‡Ú-

ÍÓ Á‡„Î‡‚ËÂ.

àÎ˛ÒÚ‡ˆËËÚÂ / ÙË„ÛË, ‰Ë‡„‡ÏË, ÙÓÏÛÎË/ Úfl·‚‡ ‰‡ Ò‡ „Ó-

ÚÓ‚Ë Á‡ ÌÂÔÓÒÂ‰ÒÚ‚ÂÌÓ ÔÓÎË„‡ÙË˜ÌÓ ‚˙ÁÔÓËÁ‚ÂÊ‰‡ÌÂ. íÂÍÒÚÓ‚Â-

ÚÂ ÔÓ‰ ÙË„ÛËÚÂ ÒÂ ÔÂ‰ÒÚ‡‚flÚ Ì‡ ÓÚ‰ÂÎÂÌ ÎËÒÚ

äÌË„ÓÔËÒ˙Ú ‰‡ ÒÂ ÓÚÔÂ˜‡Ú‡ Ì‡ ÓÚ‰ÂÎÂÌ ÎËÒÚ. Ä‚ÚÓËÚÂ ‰‡

ÒÂ ÔÓ‰ÂÊ‰‡Ú ÔÓ ‡Á·Û˜ÂÌ Â‰, Í‡ÚÓ ‚ Ì‡˜‡ÎÓÚÓ ÒÂ ËÁ·Ófl‚‡Ú ËÁÚÓ˜-

ÌËˆËÚÂ Ì‡ ÍËËÎËˆ‡, ‡ ÒÎÂ‰ Úflı Ì‡ Î‡ÚËÌËˆ‡. á‡„Î‡‚ËflÚ‡ ‰‡ ÒÂ ÔÂ‰-

ÒÚ‡‚flÚ ËÁˆflÎÓ. Ç ÚÂÍÒÚ‡ ˆËÚË‡ÌËÚÂ ‡‚ÚÓË ‰‡ ÒÂ ÔÂ‰ÒÚ‡‚flÚ Ò

ÔÓÂ‰ÂÌ ÌÓÏÂ ÓÚ ÍÌË„ÓÔËÒ‡. Ñ‡ÌÌËÚÂ ‚ ÍÌË„ÓÔËÒ‡ ÒÂ ÔÂ‰ÒÚ‡‚flÚ

ÔÓ ÒÎÂ‰ÌËfl Ì‡˜ËÌ:

ëÚ‡ÚËfl ÓÚ ÒÔËÒ‡ÌËÂ : Ä‚ÚÓ /Ë/. á‡„Î‡‚ËÂ Ì‡ ÒÚ‡ÚËflÚ‡. á‡„-

Î‡‚ËÂ Ì‡ ÒÔËÒ‡ÌËÂÚÓ / Ò˙Í‡ÚÂÌÓ ÔÓ Index medicus/, ÚÓÏ, „Ó‰ËÌ‡ Ì‡

ËÁ‰‡‚‡ÌÂ, ÌÓÏÂ Ì‡ ÍÌËÊÍ‡Ú‡, ÒÚ‡ÌËˆ‡ / ÓÚ-‰Ó/. èËÏÂ :

Andersen, G., Vestergaard, K., Lauritzen, L. Effective treatment of post-

stroke depression with the selective serotonin reuptake inhibitor citalo-

pram. Stroke, 25, 1994, 6, 1099-1104.

äÌË„‡ : Ä‚ÚÓ /Ë/ . á‡„Î‡‚ËÂ. èÓ‰Á‡„Î‡‚ÌË ‰‡ÌÌË. åÂÒÚÓËÁ‰‡-

‚‡ÌÂ, ËÁ‰‡ÚÂÒÚ‚Ó, „Ó‰ËÌ‡ Ì‡ ËÁ‰‡‚‡ÌÂ, ÒÚ‡ÌËˆ‡ /ÓÚ-‰Ó/.èËÏÂ :

Calligaro,K., DeLaurentis, D., Baker, W. Management of Extracranial

Cerebrovascular Disease.Philadelphia-New York, Lippincott - Raven

Publishers, 1997, 217.

èÛ·ÎËÍ‡ˆËË ÓÚ Ò·ÓÌËÍ : Ä‚ÚÓ /Ë/. á‡„Î‡‚ËÂ: - Ç: á‡„Î‡‚ËÂ Ì‡

Ò·ÓÌËÍ‡. àÁ‰‡ÚÂÎ /Ë/. åÂÒÚÓËÁ‰‡‚‡ÌÂ, „Ó‰ËÌ‡ Ì‡ ËÁ‰‡‚‡ÌÂ, ÒÚ‡ÌË-

ˆ‡ / ÓÚ-‰Ó/. èËÏÂ : Binnie, C. , Jeavsons , .M. Photosensitive epilep-

sies. In : Epileptic syndromes in infancy, childhood and adolescence , eds.

J.Roger, M. Bureau, Ch.Dravet, F.E. Dreifuss, A.Perret , P.Wolf. London,

John Libbey & Company, Ltd, 1992, 299-305.

Ä‚ÚÓËÚÂ ÔÓ‰ÔËÒ‚‡Ú ‰ÂÍÎ‡‡ˆËfl, ˜Â ÔÂ‰ÓÒÚ‡‚ÂÌËfl Ï‡ÚÂË-

‡Î ÌÂ Â ÔÂ‰ÎÓÊÂÌ Á‡ ÔÂ˜‡Ú Ì‡ ‰Û„Ó ÏflÒÚÓ.

èÂ‰ÓÒÚ‡‚ÂÌËÚÂ Ï‡ÚÂË‡ÎË Ë ÓÔËÒ‡ÌËÚÂ ‚ Úflı ËÁÒÎÂ‰‚‡ÌËfl

Úfl·‚‡ ‰‡ ÓÚ„Ó‚‡flÚ Ì‡ ÂÚË˜ÌËÚÂ ÒÚ‡Ì‰‡ÚË

èË Ò˙‡‚ÚÓÒÚ‚Ó ÛÚ‚˙‰ÂÌ‡Ú‡ Á‡ ÔÂ˜‡Ú ÒÚ‡ÚËfl Úfl·‚‡ ‰‡

·˙‰Â ÔÓ‰ÔËÒ‡Ì‡ ÓÚ ‚ÒË˜ÍË ‡‚ÚÓË.

ê˙ÍÓÔËÒËÚÂ ‚ ‰‚‡ ÂÍÁÂÏÔÎfl‡ (ËÎË Â‰ËÌ ÂÍÁÂÏÔÎfl Ë ‰ËÒÍÂÚ‡)

ËÁÔ‡˘‡ÈÚÂ Ì‡ ‡‰ÂÒ :

ëÓÙËfl 1504, ìÎ. 4 ÅflÎÓ ÏÓÂ " ‹ 8åÅÄã " ñ‡Ëˆ‡ âÓ‡ÌÌ‡" - ÖÄÑ äÎËÌËÍ‡ ÔÓ ÌÂ‚ÓÎÓ„Ëfl èÓÙ. è.ëÚ‡ÏÂÌÓ‚‡

INSTRUCTION FOR AUTHORS

Bulgarian Neurology is the official journal of the Bulgarian Society

of Neurology. It will consider for publication papers in neurology and

related areas in the following categories:

-Editorials, consisting of up to 3 pages, when approved by the

Editorial Board

-Original papers - up to 8 pages, including tables, figures and ref-

erences. An abstract in Bulgarian and English up to 40 rows on a sepa-

rate sheet is required. The abstract should contain title, authors, objec-

tive, background, methods, results and conclusions plus up to 6 keywords.

The original papers include short introduction, material, methods

results, discussion and references.

The title page should carry the full title, the short running title, the

authors with their initials, academic degrees, institutional affiliations,

address for correspondence, with telephone, fax and e-mail

-Short communications and case reports up to 3 pages

-Review articles up to 10 pages

-Book reviews and information. It includes information for new

books, congresses and conferences, new drugs, future events in neurolo-

gy

-Letters to the Editor with comments on previously published

papers, short case reports and discussion on current problems

-The manuscripts should be submitted on diskette / 3.5 inch/ using

Word 6/Windows 96 or Word7/Windows 98 with a printed copy.

The tables should be presented on separate sheets with a short

heading

The illustrations /figures, diagrams, formulas/ should be ready for

reproduction.

Explanatory legends should be provided on a separate sheet of paper.

References should be presented in alphabetic order on a separate

sheet with all authors` names and full title of papers . In the text the

authors should be indicated by the number from the reference list .

The reference should be presented as follows:

Journal paper : (1) author(s), (2)title, (3) journal name ( as abbre-

viated in Index Medicus ). (4) volume, (5) year of publication, (6) jour-

nal number , (7) inclusive pages. Example: Andersen, G., Vestergaard, K.,

Lauritzen, L. Effective treatment of poststroke depression with the selec-

tive serotonin reuptake inhibitor citalopram. Stroke, 25, 1994, 6, 1099-

1104.

Book : (1) author(s), (2) title, (3) city of publication, (4) publisher,

(5) year of publication , (6) pages. Example : Calligaro,K., DeLaurentis,

D., Baker, W. Management of Extracranial Cerebrovascular

Disease.Philadelphia-New York, Lippincott - Raven Publishers, 1997,

217.

References to books : (1) authors(s), (2) chapter title, (3) title of

book, (4) editor(s), (5) city of publication, (6) publisher, (7) year of pub-

lication, (8) specific pages. Example : Binnie, C. , Jeavsons , .M.

Photosensitive epilepsies. In : Epileptic syndromes in infancy, childhood

and adolescence , eds. J.Roger, M. Bureau, Ch.Dravet, F.E. Dreifuss,

A.Perret , P.Wolf. London, John Libbey & Company, Ltd, 1992, 299-305.

The articles are considered for publication on the understanding

that the presented material has not been published or is being submitted

elsewhere before appearing in BULGARIAN NEUROLOGY.

Authors should indicate that ethical approval of the study was

granted and that informed consent was given.

All authors should approve and sign the final manuscript.

Manuscript with one copy (or a diskette and a copy) should be sent

to the following address:

Sofia 1504, Bulgaria, 8, Bialo more str.Department of Neurology University Hospital ◊ Queene Jovanna“: Prof. P. Stamenova

Å˙Î„‡ÒÍ‡ çÂ‚ÓÎÓ„Ëfl Bulgarian Neurology

Å˙Î„‡ÒÍ‡ çÂ‚ÓÎÓ„Ëfl Bulgarian Neurology

ëöÑöêÜÄçàÖ

éÅáéêà

èéãàçÖÇêéèÄíàü à åàéèÄíàü èêàäêàíàóçà ëöëíéüçàüå. åËÎ‡ÌÓ‚‡, Ñ. ÄÚ‡Ì‡ÒÓ‚‡, ç. åÛ‡‰flÌ, å. ê‡‰Â‚‡ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

ÑÖäéåèêÖëàÇçÄ äêÄçàéíéåàü èêà ãÖóÖçàÖ çÄ åÄãàÉçÖç åéáöóÖçàçîÄêäíÖ. Ç‡‚ÂÍ, ë. àÒ‡ÍÓ‚, Ñ. ÄÚ‡Ì‡ÒÓ‚‡, å. åËÎ‡ÌÓ‚‡ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

éêàÉàçÄãçà ëíÄíàà

AXURA áÄ ãÖóÖçàÖ çÄ ìåÖêÖçÄ äöå íÖÜäÄ îéêåÄ çÄ ÅéãÖëííÄ çÄ ÄãñïÄâåÖê. éí ÖäëèÖêàåÖçíÄ äöå äãàçàóçÄíÄ èêÄäíàäÄëÚ. üÌ˜Â‚‡ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

ÖèàãÖèëàü à åéáöóçà äÄÇÖêçéåàê. èÓÔÓ‚, ü. ÖÌ˜Â‚, ä. åËÌÍËÌ, Ç. ÅÛÒ‡ÒÍË, ä. êÓÏ‡ÌÒÍË, å. ÇËÍÚÓÓ‚‡ . . . . . . . . . . . . . . . . . .12

ÑÇàÉÄíÖãçÄ àçÇÄãàÑàáÄñàü, äéÉçàíàÇçà à ÖåéñàéçÄãçà çÄêìòÖçàü èêà Åéãçà ë èÄêäàçëéçéÇÄ ÅéãÖëíÑ. ïËÒÚÓ‚‡, á. á‡ı‡ËÂ‚, à. ÉÓÁ‰Â‚ . . . . . . . . . .15

ASPECTS - áçÄóÖçàÖ çÄ êÄççàíÖ äí ÅÖãÖáà èêà Åéãçà ë àëïÖåàóÖçåéáöóÖç àçëìãí Ç ÅÄëÖâçÄ çÄ ëêÖÑçÄ åéáöóçÄ ÄêíÖêàüÖ. Ç‡‚ÂÍ, å. äÎËÒÛÒÍË . . . . . . . . . . . . . . . . . . . . .20

HIP-SPINE ëàçÑêéå èêÖÑà à ëãÖÑ ÖçÑéèêéíÖáàêÄçÖ çÄ íÄáéÅÖÑêÖçÄ ëíÄÇÄè. ÄÚ‡Ì‡ÒÓ‚‡, Ä. ÄÚ‡Ì‡ÒÓ‚, ç. í‡ÈÍÓ‚‡,å. ëÂÏÂ‰ÊËÂ‚‡, à. äÓÎÂ‚‡ . . . . . . . . . . . . . . . . . .24

êÄççÄ èéëíéèÖêÄíàÇçÄ èêéîàãÄäíàäÄ çÄ ÖèàãÖèíàóçà èêàëíöèà ë DEPAKINÖ CHRONO èêà Åéãçà ë åéáöóçà íìåéêàâ. è‡ÌÓ‚, ê. ä‡ÎÔ‡˜ÍË . . . . . . . . . . . . . . . . . . . . . . .27

àçîéêåÄñàà

éÅìóàíÖãÖç äìêë çÄ ÖÇêéèÖâëäÄíÄîÖÑÖêÄñàü çÄ çÖÇêéãéÉàóçàíÖ ÑêìÜÖëíÇÄ à ëöÇåÖëíçÄ çÄìóçÄ ëêÖôÄ çÄ ÖÇêéèÖâëäÄíÄ à ÅöãÉÄêëäÄíÄÄëéñàÄñàü èé çÖÇêééçäéãéÉàü à. ÇÂÎ˜Â‚‡ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30

ëöéÅôÖçàÖ

ëöéÅôÖçàÖ éí êÖÑÄäñàéççÄíÄ äéãÖÉàü çÄ ëèàëÄçàÖ ◊ÅöãÉÄêëäÄçÖÇêéãéÉàü . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32

CONTENTS

REVIEWS

CRITICAL ILLNESS POLYNEUROPATHY AND MYOPATHYM. Milanova, D. Atanasova, N. Muradyan, M. Radeva . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

TREATMENT OF PATIENTS WITH MALIGNANTSTROKE WITH DECOMPRESSIVE CRANIALSURGERYE. Vavrek, S. Isakov, D. Atanasova, M. Milanova . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

ORIGINAL PAPERS

AXURA IN THE TREATMENT OF MODERATE TO SEVERE ALZHEIMER’S DISEASE

St. Yancheva . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

BRAIN CAVERNOMAS AND EPILEPSYR. Popov, Y. Enchev, K. Minkin, V. Bussarsky, K. Romansky, M. Viktorova . . . . . . . . . . . . . . . . . . . .12

LOCOMOTORIAL INCAPACITATION, COGNITIVE AND EMOTIONAL IMPAIRMENT IN PARKINSON’S DISEASEPATIENTS.D. Hristova, Z. Zahariev, I. Grozdev . . . . . . . . . . . . .15

ASPECTS – THE ROLE OF EARLY CT SIGNS IN PATIENTS WITH ACUTE MIDDLE CEREBRAL ARTERY ISCHEMIC STROKEE. Vavrek, M. Klissurski . . . . . . . . . . . . . . . . . . . . . .20

HIP-SPINE SYNDROME BEFORE AND AFTER TOTAL HIP REPLACEMENTP. Atanassova, A. Atanassov, N. Traykova, M. Semerdjieva, I. Koleva . . . . . . . . . . . . . . . . . . . . .24

EARLY POSTOPERATIVE PROPHYLACTIC ANTICONVULSANT TREATMENT WITH DEPAKINE CHRONO IN BRAIN TUMOR PATIENTSY. Panov, R KalpachÍi . . . . . . . . . . . . . . . . . . . . . . .27

INFORMATION

EFNS TEACHING COURSE AND JOINT EANO/BANO MEETING

I. Velcheva . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30

ANNOUNCEMENT

INFORMATION OF THE EDITORIAL BOARD OF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32

SUMMARY

CRITICAL ILLNESS POLYNEUROPATHYAND MYOPATHY

M. Milanova, D. Atanasova, N. Muradyan, M. RadevaCritical illness polyneuropathy and myopathy, developing

independently or in association, are common causes of theworsening in condition of patients in intensive care units. Inmost cases polyneuropathy is connected with sepsis and mul-tiple organ failure and myopathy is usually observed inpatients, treated with high doses of steroids and neuro-muscu-lar blocking agents for severe asthma exacerbations.Commonly the both conditions are well differentiated upontheir clinical presentation, provoking conditions, electrophys-iologic and morphologic features

KEY WORDS: critical illness polyneuropathy, critical illness myopathy, electromyography.

êÖáûåÖ

èÓÎËÌÂ‚ÓÔ‡ÚËfl Ë ÏËÓÔ‡ÚËfl ÔË ÍËÚË˜ÌË Ò˙ÒÚÓfl-ÌËfl, ‡Á‚ËÎË ÒÂ Ò‡ÏÓÒÚÓflÚÂÎÌÓ ËÎË ‚ ÍÓÏ·ËÌ‡ˆËfl, Ò‡ ˜ÂÒ-ÚË ÔË˜ËÌË Á‡ ‚ÎÓ¯‡‚‡ÌÂ Ì‡ Ò˙ÒÚÓflÌËÂÚÓ Ì‡ Ô‡ˆËÂÌÚË-ÚÂ, ÎÂÍÛ‚‡ÌË ‚ ËÌÚÂÌÁË‚ÌË ÓÚ‰ÂÎÂÌËfl. Ç ÔÓ‚Â˜ÂÚÓ ÒÎÛ-˜‡Ë ÔÓfl‚‡Ú‡ Ì‡ ÔÓÎËÌÂ‚ÓÔ‡ÚËflÚ‡ Â Ò‚˙Á‡Ì‡ Ò˙Ò ÒÂÔÒËÒË ÏÛÎÚËÓ„‡ÌÌ‡ ÌÂ‰ÓÒÚ‡Ú˙˜ÌÓÒÚ, Ò˙˘Â‚ÂÏÂÌÌÓ ÏËÓÔ‡-ÚËflÚ‡ Ó·ËÍÌÓ‚ÂÌÌÓ ÒÂ Ì‡·Î˛‰‡‚‡ ÔË Ô‡ˆËÂÌÚË, ÎÂÍÛ‚‡-ÌË Á‡ ‡ÒÚÏ‡ÚË˜ÂÌ ÒÚ‡ÚÛÒ Ò ‚ËÒÓÍË ‰ÓÁË ÍÓÚËÍÓÒÚÂÓ-Ë‰Ë Ë ÌÂ‚ÌÓ-ÏÛÒÍÛÎÌË ·ÎÓÍÂË. Ñ‚ÂÚÂ Á‡·ÓÎfl‚‡ÌËfl Ó·ËÍ-ÌÓ‚ÂÌÌÓ Ò‡ ‰Ó·Â ‡Á„‡ÌË˜ËÏË ÔÓ ÍÎËÌË˜Ì‡Ú‡ ÔÂÁÂÌÚ‡-ˆËfl, ÔÓ‚ÓÍË˘Ë Ò˙ÒÚÓflÌËfl, ÂÎÂÍÚÓÙËÁËÓÎÓ„Ë˜Ì‡ Ë Ô‡-ÚÓÏÓÙÓÎÓ„Ë˜Ì‡ Ì‡ıÓ‰Í‡.

äãûóéÇà Ñìåà: ÔÓÎËÌÂ‚ÓÔ‡ÚËfl ÔË ÍËÚË˜ÌËÒ˙ÒÚÓflÌËfl, ÏËÓÔ‡ÚËfl ÔË ÍËÚË˜ÌË Ò˙ÒÚÓflÌËfl, ÂÎÂÍÚ-ÓÏËÓ„‡ÙËfl.

ê‡Á‚ËÚËÂÚÓ Ì‡ ÒÎ‡·ÓÒÚ Ì‡ ‰Ëı‡ÚÂÎÌ‡Ú‡ ÏÛÒÍÛÎ‡ÚÛ‡Ë/ËÎË Ì‡ ÏÛÒÍÛÎËÚÂ Ì‡ Í‡ÈÌËˆËÚÂ ÔË Ô‡ˆËÂÌÚË ‚ ÍË-ÚË˜ÌÓ Ò˙ÒÚÓflÌËÂ Â ˜ÂÒÚÓ ÛÒÎÓÊÌÂÌËÂ, Â„ËÒÚË‡ÌÓ ‚ÓÚ‰ÂÎÂÌËflÚ‡ Á‡ ËÌÚÂÌÁË‚ÌÓ ÎÂ˜ÂÌËÂ (5). àÏÂÌÌÓ ÚÂ Ò‡ÔË˜ËÌ‡Ú‡ Á‡ ‚ÎÓ¯‡‚‡ÌÂ ıÓ‰‡ Ì‡ ÓÒÌÓ‚ÌÓÚÓ Á‡·ÓÎfl‚‡ÌÂ,ÍÓÂÚÓ ÍÎËÌË˜ÌÓ ÒÂ ‡ÁÔÓÁÌ‡‚‡ Ò˙Ò Á‡ÚÛ‰ÌÂÌÓ ‰Ó ÌÂ‚˙Á-ÏÓÊÌÓ ÒÔË‡ÌÂ Ì‡ ÔÓ‰˙ÎÊËÚÂÎÌ‡Ú‡ ËÁÍÛÒÚ‚ÂÌ‡ ·ÂÎÓ‰-Ó·Ì‡ ‚ÂÌÚËÎ‡ˆËfl. èÓÎËÌÂ‚ÓÔ‡ÚËfl Ë/ËÎË ÏËÓÔ‡ÚËfl ÔËÍËÚË˜ÌË Ò˙ÒÚÓflÌËfl (èäë Ë åäë), ‡Á‚ËÎË ÒÂ Ò‡ÏÓÒÚÓ-flÚÂÎÌÓ ËÎË ‚ ÍÓÏ·ËÌ‡ˆËfl, Ò‡ Ì‡È-˜ÂÒÚËÚÂ ÔË˜ËÌË Á‡‚ÎÓ¯‡‚‡ÌÂ Ì‡ Ò˙ÒÚÓflÌËÂÚÓ Ì‡ Ô‡ˆËÂÌÚËÚÂ, ÎÂÍÛ‚‡ÌË ‚ËÌÚÂÌÁË‚ÌËÚÂ ÓÚ‰ÂÎÂÌËfl. èÓ-fl‰ÍÓ ‚ ÎËÚÂ‡ÚÛ‡Ú‡ Ò‡ÓÔËÒ‡ÌË ÒÎÛ˜‡Ë Ì‡ ‚˙‚ÎË˜‡ÌÂ ‚ ÍÎËÌË˜Ì‡Ú‡ Í‡ÚËÌ‡ Ë Ì‡ÎËˆÂ‚‡Ú‡ ÏÛÒÍÛÎ‡ÚÛ‡ Ë Ú‡ÁË Ì‡ ‚˙Ì¯ÌËÚÂ Ó˜ÌË ÏÛÒÍÛ-ÎË (6, 7, 33).

ë˙‚ÂÏÂÌÌÓÚÓ Òı‚‡˘‡ÌÂ Á‡ Ô‡ˆËÂÌÚ ‚ ÍËÚË˜ÌÓ Ò˙Ò-ÚÓflÌËÂ Â, ˜Â ÚÓ ÔÂ‰ÒÚ‡‚Îfl‚‡ Ò˙ÒÚÓflÌËÂ Ì‡ ÒËÒÚÂÏÌ‡‚˙ÁÔ‡ÎËÚÂÎÌ‡ Â‡ÍˆËfl, ÍÓflÚÓ ‚˙ÁÌËÍ‚‡ ÔË 20% ‰Ó 50%ÓÚ Ô‡ˆËÂÌÚËÚÂ ËÁËÒÍ‚‡˘Ë ÔÓ‰˙ÎÊËÚÂÎÌ‡ ËÁÍÛÒÚ‚ÂÌ‡‡Ô‡‡ÚÌ‡ ‚ÂÌÚËÎ‡ˆËfl (ÔÓ‚Â˜Â ÓÚ Â‰Ì‡ ÒÂ‰ÏËˆ‡) (5). ç‡È-˜ÂÒÚÓ Ú‡Í˙‚ ÒËÒÚÂÏÂÌ ‚˙ÁÔ‡ÎËÚÂÎÂÌ ÓÚ„Ó‚Ó ÒÂ ‡Á‚Ë‚‡ÔË ÒÂÔÚË˜ÌË Ò˙ÒÚÓflÌËfl, Ò˙ÔÓ‚Ó‰ÂÌË Ò ÏÛÎÚËÓ„‡ÌÌ‡ÌÂ‰ÓÒÚ‡Ú˙˜ÌÓÒÚ. èÓ‚Â˜ÂÚÓ ËÁÒÎÂ‰Ó‚‡ÚÂÎË Ò‚˙Á‚‡Ú ÔÓ-

fl‚‡Ú‡ Ì‡ ÔÓÎËÌÂ‚ÓÔ‡ÚËflÚ‡ Í‡ÚÓ ÎÓ„Ë˜ÌÓ ÛÒÎÓÊÌÂÌËÂ Ì‡Ò˙ÒÚÓflÌËfl, ÔÓÚË˜‡˘Ë Ò ÏÛÎÚËÓ„‡ÌÌ‡ ÌÂ‰ÓÒÚ‡Ú˙˜-ÌÓÒÚ. ê‡Á‚ËÚËÂÚÓ Ì‡ ÏËÓÔ‡ÚËflÚ‡ Â Ì‡·Î˛‰‡‚‡ÌÓ ÔÓ-˜ÂÒ-ÚÓ ÔË Ô‡ˆËÂÌÚË, ÎÂÍÛ‚‡ÌË Á‡ ‡ÒÚÏ‡ÚË˜ÂÌ ÒÚ‡ÚÛÒ,ËÁËÒÍ‚‡˘ ËÁÍÛÒÚ‚ÂÌ‡ ·ÂÎÓ‰Ó·Ì‡ ‚ÂÌÚËÎ‡ˆËfl (àÅÇ), ‚Ë-ÒÓÍË ‰ÓÁË ËÌÚ‡‚ÂÌÓÁÌË ÍÓÚËÍÓÒÚÂÓË‰Ë Ë ÌÂ‚ÌÓ-ÏÛÒ-ÍÛÎÌË ·ÎÓÍÂË (5).

ÑË‡„ÌÓÒÚËˆË‡ÌÂÚÓ Ë ‡ÁÎË˜‡‚‡ÌÂÚÓ Ì‡ ‰‚ÂÚÂ ÛÒÎÓÊ-ÌÂÌËfl – ÔÓÎËÌÂ‚ÓÔ‡ÚËfl Ë ÏËÓÔ‡ÚËfl ÔË ÍËÚË˜ÌË Ò˙Ò-ÚÓflÌËfl Â ‚‡ÊÌÓ Á‡ ÍÎËÌË˜Ì‡Ú‡ Ô‡ÍÚËÍ‡ Ò Ó„ÎÂ‰ Á‡ÔÓ˜‚‡-ÌÂ Ì‡ ‡ÌÌÓ ÎÂ˜ÂÌËÂ Ë ÔÓ‰Ó·fl‚‡ÌÂ Ì‡ ÔÓ„ÌÓÁ‡Ú‡ ÔË Ô‡-ˆËÂÌÚËÚÂ, ÎÂÍÛ‚‡ÌË ‚ ËÌÚÂÌÁË‚ÌË ÓÚ‰ÂÎÂÌËfl. ÇÒ˙˘ÌÓÒÚ‰‚ÂÚÂ Á‡·ÓÎfl‚‡ÌËfl ‚ ÔÓ‚Â˜ÂÚÓ ÒÎÛ˜‡Ë Ò‡ ‰Ó·Â ‡Á„‡ÌË-˜ËÏË ÔÓ Ò‚ÓflÚ‡ ÍÎËÌË˜Ì‡ ÔÂÁÂÌÚ‡ˆËfl, ÔÓ‚ÓÍË‡˘ËÒ˙ÒÚÓflÌËfl, ÂÎÂÍÚÓÙËÁËÓÎÓ„Ë˜Ì‡ Ë Ô‡ÚÓÏÓÙÓÎÓ„Ë˜Ì‡Ì‡ıÓ‰Í‡. ÖÚÓ Á‡˘Ó ÂÎÂÍÚÓÏËÓ„‡ÙËflÚ‡ Ë ÏÛÒÍÛÎÌ‡Ú‡·ËÓÔÒËfl Ò‡ ËÁÒÎÂ‰‚‡ÌËflÚ‡ Ì‡ Ô˙‚Ë ËÁ·Ó ÔË ‰Ë‡„ÌÓÒÚË-ˆË‡ÌÂÚÓ Ì‡ ÚÂÁË ÛÒÎÓÊÌÂÌËfl.

ñÂÎÚ‡ Ì‡ Ì‡ÒÚÓfl˘Ëfl ÎËÚÂ‡ÚÛÂÌ Ó·ÁÓ Â ‰‡ ÔÂ‰Ò-Ú‡‚Ë ÓÒÌÓ‚ÌËÚÂ ‚˙ÔÓÒË, ÍÓËÚÓ ÒÂ ‰ËÒÍÛÚË‡Ú ‚ ÎËÚÂ-‡ÚÛ‡Ú‡, Ò‚˙Á‡ÌË Ò ÛÒÎÓÊÌÂÌËflÚ‡ ÔË Ô‡ˆËÂÌÚË ‚ ÍË-ÚË˜ÌË Ò˙ÒÚÓflÌËfl, ËÁËÒÍ‚‡˘Ë àÅÇ:

1. ä‡Í˙‚ Â ÌÓÁÓÎÓ„Ë˜ÌËfl ÒÔÂÍÚ˙ ÓÚ ÌÂ‚ÌÓ-ÏÛÒÍÛÎÌËÛÒÎÓÊÌÂÌËfl, ÎÂÍÛ‚‡ÌË ‚ ËÌÚÂÌÁË‚ÌËÚÂ ÓÚ‰ÂÎÂÌËfl ËÔË˜ËÌfl‚‡˘Ë ‰Ëı‡ÚÂÎÌ‡ Ë „ÂÌÂ‡ÎËÁË‡Ì‡ ÏÛÒÍÛÎÌ‡ÒÎ‡·ÓÒÚ?;

2. Ñ‡ÎË ‚Ë‰‡ Ì‡ ÍÎËÌË˜Ì‡Ú‡ ÔÂÁÂÌÚ‡ˆËfl Ë ‰‡ÌÌË Á‡ÔÂ‰¯ÂÒÚ‚‡˘Ó ÎÂ˜ÂÌËÂ Ò ÍÓÚËÍÓÒÚÂÓË‰Ë Ë ÌÂ‚-ÌÓ-ÏÛÒÍÛÎÌË ·ÎÓÍÂË ÏÓ„‡Ú ‰‡ ·˙‰‡Ú ÔÓÎÂÁÌË Í‡ÚÓ‰Ë‡„ÌÓÒÚË˜ÌË Ï‡ÍÂË Ì‡ÒÓ˜‚‡˘Ë Á‡ ‡Á‚ËÚËÂ ÔÓ-ÒÍÓÓ Ì‡ ÏËÓÔ‡ÚËfl, ÓÚÍÓÎÍÓÚÓ Ì‡ ÔÓÎËÌÂ‚ÓÔ‡-ÚËfl?;

3. åÓÊÂ ÎË ‰‡ ÒÂ ÓÔÂ‰ÂÎflÚ Ì‡‰ÂÊ‰ÌË ÍÎËÌË˜ÌË ËÂÎÂÍÚÓÏËÓ„‡ÙÒÍË ·ÂÎÂÁË, ÍÓËÚÓ ‰‡ ÓÒË„ÛflÚ ÒË-„ÛÌÓ ‡Á„‡ÌË˜‡‚‡ÌÂ Ì‡ ‰‚ÂÚÂ ÛÒÎÓÊÌÂÌËfl?; 4/.Ç‡ÊÌÓ ÎË Â ÓÚ‰ËÙÂÂÌˆË‡ÌÂÚÓ Ì‡ ÔÓÎËÌÂ‚ÓÔ‡ÚË-flÚ‡ Ë ÏËÓÔ‡ÚËflÚ‡ ÔË ÍËÚË˜ÌË Ò˙ÒÚÓflÌËfl?

àëíéêàóÖëäà ÑÄççà

èÓÎËÌÂ‚ÓÔ‡ÚËflÚ‡ Ë ÏËÓÔ‡ÚËflÚ‡ Ò‡ ÛÒÎÓÊÌÂÌËfl, ÍÓËÚÓ ÏÓÊÂ ·Ë ‚ËÌ‡„Ë Ò‡ Ò˙Ô˙ÚÒÚ‚‡ÎË ÒÂÔÚË˜ÌËÚÂ Ò˙Ò-ÚÓflÌËfl. èÂ‰Ë ‡Á‚ËÚËÂÚÓ Ì‡ Í‡‰ËÓˆËÍÛÎ‡ÚÓÌ‡Ú‡Â‡ÌËÏ‡ˆËfl Ë ÎÂ˜ÂÌËÂ Ò àÅÇ, ÎÂÚ‡ÎÌËfl ËÁıÓ‰ ÔË ÚÂÁËÔ‡ˆËÂÌÚË Â ‚˙ÁÔÂÔflÚÒÚ‚‡Î ‰Ë‡„ÌÓÒÚËˆË‡ÌÂÚÓ Ì‡Ú‡Í˙‚ Ó‰ ÛÒÎÓÊÌÂÌËfl. èÂÁ 1892 „Ó‰ËÌ‡ W. Osler Ô˙‚ÓÔËÒ‡Î ·˙ÁÓ ‡Á‚ËÚËÂ Ì‡ ÏÛÒÍÛÎÌ‡ ÒÎ‡·ÓÒÚ ÔË Ô‡ˆËÂÌ-ÚË Ò ÔÓ‰˙ÎÊËÚÂÎÂÌ ÒÂÔÒËÒ (20). èÂÁ 1955 „Ó‰ËÌ‡ F. Erbsloh Â„ËÒÚË‡Î ‡Á‚ËÚËÂ Ì‡ ÔÓÎËÌÂ‚ÓÔ‡ÚËfl ÒÎÂ‰Ò˙ÒÚÓflÌËÂ Ì‡ ‡ÌÓÍÒË˜Ì‡ ÍÓÏ‡ Ë ÒÔË‡ÌÂ Ì‡ Ò˙‰Â˜Ì‡ ‰ÂÈ-ÌÓÒÚ (10). èÂÁ 1961 „Ó‰ËÌ‡ H. Mertens ÓÔËÒ‚‡ ÌflÍÓÎÍÓÒÎÛ˜‡Ë Ì‡ ,,ÍÓÏ‡-ÔÓÎËÌÂ‚ÓÔ‡ÚËË” ÔË Ô‡ˆËÂÌÚË ÔÂÊË-‚flÎË ˆËÍÛÎ‡ÚÓÂÌ ¯ÓÍ, Ò‚˙Á‡Ì Ò ÓÒÚË ËÌÚÓÍÒËÍ‡ˆËË ËÚÂÊÍË ‰ËÒÏÂÚ‡·ÓÎËÚÌË Ì‡Û¯ÂÌËfl (18).

íÂÏËÌ˙Ú ,,ÔÓÎËÌÂ‚ÓÔ‡ÚËfl ÔË ÍËÚË˜ÌË Ò˙ÒÚÓfl-ÌËfl” Â ‚˙‚Â‰ÂÌ Á‡ Ô˙‚Ë Ô˙Ú ÓÚ D. Zochodne, C. Bolton ËÒ˙‡‚ÚÓË ÔÂÁ 1987 „Ó‰ËÌ‡ (32). íÂÁË ‡‚ÚÓÒÍË ÍÓÎÂÍÚË-‚Ë Ò‡ ÓÔËÒ‡ÎË ÒÎÛ˜‡Ë Ò ‡Á‚ËÚËÂ Ì‡ ÏÛÒÍÛÎÌ‡ ÒÎ‡·ÓÒÚ Ë

Å˙Î„‡ÒÍ‡ çÂ‚ÓÎÓ„Ëfl Bulgarian Neurology 1Ï‡Ú, 2008

é·ÁÓèéãàçÖÇêéèÄíàü à åàéèÄíàü èêà äêàíàóçà

ëöëíéüçàü

å. åËÎ‡ÌÓ‚‡, Ñ. ÄÚ‡Ì‡ÒÓ‚‡, ç. åÛ‡‰flÌ, å. ê‡‰Â‚‡ìåÅÄã “ñ‡Ëˆ‡ âÓ‡ÌÌ‡ - àëìã”, äÎËÌËÍ‡ ÔÓ ÌÂ‚ÓÎÓ„Ëfl, ëÓÙËfl

ÌÂ‚˙ÁÏÓÊÌÓÒÚ Á‡ ÒÔË‡ÌÂ Ì‡ ÎÂ˜ÂÌËÂ Ò àÅÇ ÔË Ô‡ˆËÂÌÚË‚ ÒÂÔÚË˜ÌÓ Ò˙ÒÚÓflÌËÂ. (2, 3). óÂÁ ÂÎÂÍÚÓÏËÓ„‡ÙÒÍÓ ËÔ‡ÚÓÏÓÙÓÎÓ„Ë˜ÌÓ ËÁÒÎÂ‰‚‡ÌÂ Ò‡ ÛÒÚ‡ÌÓ‚ËÎË ‰‡ÌÌË Á‡ÔÂ‰ËÏÌÓ ‰ËÒÚ‡ÎÌ‡ ‡ÍÒÓÌ‡ÎÌ‡ ‰Â„ÂÌÂ‡ˆËfl Ì‡ ÒÂÚË‚ÌËÚÂË ‰‚Ë„‡ÚÂÎÌË ‚Î‡ÍÌ‡ Ì‡ ÔÂËÙÂÌËÚÂ ÌÂ‚Ë (2). ÅËÎ‡ÔÂ‰ÎÓÊÂÌ‡ ÚÂÓËfl, ˜Â ÚÓ‚‡ ÛÒÎÓÊÌÂÌËÂ ÒÂ ‰˙ÎÊË Ì‡“ÚÓÍÒË˜ÂÌ ÂÙÂÍÚ” Ì‡ ÒÂÔÚË˜ÌÓÚÓ Ò˙ÒÚÓflÌËÂ (3). èÓ-Í˙ÒÌÓ Ò˙˘ËÚÂ ‡‚ÚÓË ‰ÓÍ‡Á‡ÎË, ˜Â ÔÓÎËÌÂ‚ÓÔ‡ÚËflÚ‡ÔË ÍËÚË˜ÌÓ Ò˙ÒÚÓflÌËÂ Ë ÒËÌ‰ÓÏ˙Ú Ì‡ Guillain-BarreÒ‡ ‰‚Â ÓÚ‰ÂÎÌË ÌÓÁÓÎÓ„Ë˜ÌË Â‰ËÌËˆË, ÍÓËÚÓ ÒÂ ÓÚÎË˜‡-‚‡Ú Í‡ÍÚÓ ÔÓ ı‡‡ÍÚÂ Ì‡ ÔÂ‰ıÓÊ‰‡˘Ó ËÎË ‡ÒÓˆËË‡ÌÓÁ‡·ÓÎfl‚‡ÌÂ, Ú‡Í‡ Ë ÔÓ ÂÎÂÍÚÓÏËÓ„‡ÙÒÍËÚÂ Ë ÏÓÙÓÎÓ-„Ë˜ÌË ı‡‡ÍÚÂËÒÚËÍË (7). èÂÁ 1991 „Ó‰ËÌ‡ (29) Â ÔÓ‚Â-‰ÂÌÓ ÔÓÒÔÂÍÚË‚ÌÓ ÔÓÛ˜‚‡ÌÂ, ÍÓÂÚÓ ÛÒÚ‡ÌÓ‚fl‚‡ ‡Á‚Ë-ÚËÂ Ì‡ ÔÓÎËÌÂ‚ÓÔ‡ÚËfl ‚ 70% ÓÚ Ô‡ˆËÂÌÚËÚÂ Ò˙Ò ÒÂÔÒËÒË ÏÛÎÚËÓ„‡ÌÌ‡ ÌÂ‰ÓÒÚ‡Ú˙˜ÌÓÒÚ. ëÔÓÂ‰ ‡‚ÚÓËÚÂ‚˙ÁÏÓÊÌËflÚ Ô‡ÚÓ„ÂÌÂÚË˜ÂÌ ÏÂı‡ÌËÁ˙Ï Á‡ ‡Á‚ËÚËÂ Ì‡ÚÓ‚‡ ÛÒÎÓÊÌÂÌËÂ (èäë) Â Ò‚˙Á‡Ì Ò Ì‡Û¯ÂÌËÂ ‚ ÏËÍÓ-ˆËÍÛÎ‡ˆËflÚ‡ Ì‡ ÔÂËÙÂÌËÚÂ ÌÂ‚Ë - Í‡ÚÓ ÙÂÌÓÏÂÌ Ì‡ÏÛÎÚËÓ„‡ÌÌÓ Á‡Òfl„‡ÌÂ ÔË ÒÂÔÚË˜ÌË Ò˙ÒÚÓflÌËfl (29).

óÂÁ ÂÎÂÍÚÓÏËÓ„‡ÙÒÍËÚÂ Ë Ô‡ÚÓÏÓÙÓÎÓ„Ë˜ÌË ËÁÒ-ÎÂ‰‚‡ÌËfl Â ‰ÓÍ‡Á‡ÌÓ, ˜Â ÔË Ô‡ˆËÂÌÚË ‚ ÍËÚË˜ÌÓ Ò˙ÒÚÓfl-ÌËÂ ÏÓÊÂ ‰‡ ÒÂ Á‡ÒÂ„ÌÂ ÔÂ‰ËÏÌÓ Ì‡ÔÂ˜ÌÓÌ‡·‡Á‰ÂÌ‡Ú‡ÏÛÒÍÛÎ‡ÚÛ‡ (6, 31, 33). èË ÚÂÁË ÒÎÛ˜‡Ë Ò‡ ÛÒÚ‡ÌÓ‚ÂÌË Ì‡-Û¯ÂÌËfl ‚ ˆËÚÓ‡ıËÚÂÍÚÓÌËÍ‡Ú‡ Ë ÌÂÍÓÁ‡ Ì‡ ÏÛÒÍÛÎÌË-ÚÂ ‚Î‡ÍÌ‡. íÓ‚‡ Â ‰‡ÎÓ ÓÒÌÓ‚‡ÌËÂ ‰‡ ÒÂ ‚˙‚Â‰Â ÚÂÏËÌ‡,,ÏËÓÔ‡ÚËfl ÔË ÍËÚË˜ÌË Ò˙ÒÚÓflÌËfl” ÔÂÁ 1986 „Ó‰ËÌ‡(31). Ç ÎËÚÂ‡ÚÛ‡Ú‡ Ò˙˘ÂÒÚ‚Û‚‡Ú Â‰Ëˆ‡ Ò˙Ó·˘ÂÌËfl,ÍÓËÚÓ Ò‚˙Á‚‡Ú ÔÓfl‚‡Ú‡ Ì‡ ÏËÓÔ‡ÚËfl ÒÎÂ‰ ÔÂ‰¯ÂÒÚ‚‡-˘Ó ÎÂ˜ÂÌËÂ Ò ÍÓÚËÍÓÒÚÂÓË‰Ë Ë ÌÂ‚ÌÓ-ÏÛÒÍÛÎÌË ·ÎÓÍÂ-Ë (pancuronium, vecuronium) (1, 12, 19, 28), ÒÎÂ‰ ÎÂ˜ÂÌËÂ Ì‡‡ÒÚÏ‡ÚË˜ÂÌ ÒÚ‡ÚÛÒ Ë Ú‡ÌÒÔÎ‡ÌÚ‡ˆËË (15, 17, 25).

çéáéãéÉàóÖç ëèÖäíöê éí çÖêÇçé-åìëäìãçàìëãéÜçÖçàü, ãÖäìÇÄçà Ç àçíÖçáàÇçàíÖ

éíÑÖãÖçàü

Ç ÍÎËÌË˜Ì‡Ú‡ Ô‡ÍÚËÍ‡ ËÏ‡ ‚‡ÊÌÓ ÁÌ‡˜ÂÌËÂ ‡Á„‡ÌË-˜‡‚‡ÌÂÚÓ Ì‡ ÚÓÁË ‚Ë‰ ÛÒÎÓÊÌÂÌËfl, ÍÓËÚÓ ÔÂ‰ËÁ‚ËÍ‚‡ÚÔ˙‚Ë˜Ì‡ ÏÛÒÍÛÎÌ‡ ÒÎ‡·ÓÒÚ Ì‡ ‰Ëı‡ÚÂÎÌ‡Ú‡ ÏÛÒÍÛÎ‡ÚÛ‡Ë Ú‡ÁË Ì‡ Í‡ÈÌËˆËÚÂ (Ì‡Ô. ÒËÌ‰ÓÏ Ì‡ Guillain-Barre ËÏË‡ÒÚÂÌËfl „‡‚ËÒ) ÓÚ ÚÂÁË ÛÒÎÓÊÌÂÌËfl, ÍÓËÚÓ ÒÂ ‡Á‚Ë-‚‡Ú ÔÓ ‚ÂÏÂ Ì‡ ÔÓ‰˙ÎÊËÚÂÎÌ‡ àÅÇ (5). éÒÌÓ‚ÌËÚÂÌÂ‚ÌÓ-ÏÛÒÍÛÎÌË Ì‡Û¯ÂÌËfl, Ò‚˙Á‡ÌË Ò ‡Á‚ËÚËÂ Ì‡ ‚ÚÓ-Ë˜Ì‡ ÒÎ‡·ÓÒÚ ÔË ÍËÚË˜ÌÓ ·ÓÎÌË Ô‡ˆËÂÌÚË ‚ ËÌÚÂÌ-ÁË‚ÌËÚÂ ÓÚ‰ÂÎÂÌËfl Ò‡ ÔÓÎËÌÂ‚ÓÔ‡ÚËflÚ‡, ÏËÓÔ‡ÚËflÚ‡Ë ‚ ÔÓ-Â‰ÍË ÒÎÛ˜‡Ë – Ò˙ÒÚÓflÌËfl Ì‡ ÔÓ‰˙ÎÊËÚÂÎÂÌ ÌÂ‚-ÌÓ-ÏÛÒÍÛÎÂÌ ·ÎÓÍ. ÇÒÂ Ó˘Â ÓÒÚ‡‚‡ ‰ËÒÍÛÚ‡·ËÎÂÌ ‚˙ÔÓÒ‡‰‡ÎË èäë Ë åäë Ò‡ ‰‚Â ÓÚ‰ÂÎÌË ÌÓÁÓÎÓ„Ë˜ÌË Â‰ËÌËˆË,‰‡ÎË ËÏ‡Ú ÒıÓ‰ÂÌ Ô‡ÚÓÙËÁËÓÎÓ„Ë˜ÂÌ ÏÂı‡ÌËÁ˙Ï ËÎË ÍÎË-ÌË˜Ì‡ ÔÂÁÂÌÚ‡ˆËfl.

èéãàçÖÇêéèÄíàü èêà äêàíàóçà ëöëíéüçàü

äãàçàóçÄ äÄêíàçÄ

í˙È Í‡ÚÓ ËÁÒÎÂ‰‚‡ÌÂÚÓ Ì‡ ÌÂ‚ÌÓ-ÏÛÒÍÛÎÌ‡Ú‡ ÒËÒÚÂ-Ï‡ ÔË Ô‡ˆËÂÌÚË ‚ ÍËÚË˜ÌÓ Ò˙ÒÚÓflÌËÂ Â Á‡ÚÛ‰ÌÂÌÓ,ÔË ÔÓ-„ÓÎflÏ‡Ú‡ ˜‡ÒÚ ÓÚ Úflı ÔÓÎËÌÂ‚ÓÔ‡ÚËflÚ‡ ÌÂ ÏÓÊÂ ‰‡ ·˙‰Â ÛÒÚ‡ÌÓ‚ÂÌ‡ ÔÓ ÍÎËÌË˜ÌË ‰‡ÌÌË. ç‡È-˜ÂÒÚÓÔË ÚÂÁË Ô‡ˆËÂÌÚË ÒÂ ÓÚÍË‚‡ ÏÛÒÍÛÎÌ‡ ÒÎ‡·ÓÒÚ, ÓÚÒ˙-ÒÚ‚ËÂ Ì‡ ‰‚ËÊÂÌËfl ‚ Í‡ÈÌËˆËÚÂ ÔË ·ÓÎÍÓ‚‡ ÒÚËÏÛÎ‡-ˆËfl, ÔË Á‡Ô‡ÁÂÌ ÓÚ„Ó‚Ó ÓÚ ÎËˆÂ‚‡Ú‡ ÏÛÒÍÛÎ‡ÚÛ‡(6,7,33). èË ÔÓ-„ÓÎflÏ‡ ˜‡ÒÚ ÓÚ ÓÔËÒ‡ÌËÚÂ ÒÎÛ˜‡Ë ÏÛÒ-ÍÛÎÌ‡Ú‡ ÒÎ‡·ÓÒÚ Â ÔÓ-ËÁ‡ÁÂÌ‡ ‚ Í‡Í‡Ú‡, Í‡ÚÓ ‰ËÒÚ‡Î-ÌËÚÂ ÓÚ‰ÂÎË Ò‡ ÔÓ-Á‡ÒÂ„Ì‡ÚË ÓÚ ÔÓÍÒËÏ‡ÎÌËÚÂ.ÖÍÒÚ‡ÓÍÛÎ‡Ì‡Ú‡ ÏÛÒÍÛÎ‡ÚÛ‡ Ó·ËÍÌÓ‚ÂÌÓ ÓÒÚ‡‚‡ ÌÂ-Á‡ÒÂ„Ì‡Ú‡, ‡ ‚ ÓÚ‰ÂÎÌË ÒÎÛ˜‡Ë Â Ì‡·Î˛‰‡‚‡Ì‡ ÒÎ‡·ÓÒÚ Ì‡

ÎËˆÂ‚‡Ú‡ ÏÛÒÍÛÎ‡ÚÛ‡ (6,7,33). ëÛıÓÊËÎÌÓ-Ì‡‰ÍÓÒÚÌË-ÚÂ ÂÙÎÂÍÒË Ó·ËÍÌÓ‚ÂÌÓ Ò‡ ÒÌËÊÂÌË ËÎË ÎËÔÒ‚‡˘Ë, ÌÓ ‚ÌflÍÓË ÓÚ ÒÎÛ˜‡Ë ÚÂ ÏÓ„‡Ú ‰‡ ·˙‰‡Ú ‰ÓË Ë Á‡Ô‡ÁÂÌË. àÁÒ-ÎÂ‰‚‡ÌÂÚÓ Ì‡ ÒÂÚË‚ÌÓÒÚÚ‡ ÌÂ ÏÓÊÂ ‰‡ ·˙‰Â ÒË„ÛÌÓ, ÌÓÔË ÍÓÌÚ‡ÍÚÌË Ô‡ˆËÂÌÚË Â ÛÒÚ‡ÌÓ‚ÂÌÓ Ì‡Û¯ÂÌËÂ ÔÓ‰ËÒÚ‡ÎÂÌ ÚËÔ ‚ Í‡ÈÌËˆËÚÂ Á‡ ÛÒÂÚ‡ Ì‡ ·ÓÎÍ‡, ÚÂÏÔÂ‡-ÚÛ‡ Ë ‚Ë·‡ˆËfl.

ÖãÖäíêéåàéÉêÄîëäà àáëãÖÑÇÄçàü

àÁÒÎÂ‰‚‡ÌÂ Ì‡ ÔÓ‚Ó‰ËÏÓÒÚÚ‡ ÔÓ ‰‚Ë„‡ÚÂÎÌËÚÂ Ë ÒÂ-ÚË‚ÌË ‚Î‡ÍÌ‡ Ì‡ ÔÂËÙÂÌËÚÂ ÌÂ‚Ë, Í‡ÍÚÓ Ë Ë„ÎÂÌ‡Ú‡ÂÎÂÍÚÓÏËÓ„‡ÙËfl, Ò‡ ‚Ó‰Â˘Ë ÏÂÚÓ‰ËÍË Á‡ ‰ÓÍ‡Á‚‡ÌÂ Ì‡‡ÍÒÓÌ‡ÎÌ‡ ÒÂÚË‚ÌÓ-ÏÓÚÓÌ‡ ÔÓÎËÌÂ‚ÓÔ‡ÚËfl ÔË ÍË-ÚË˜ÌË Ò˙ÒÚÓflÌËfl. óÂÁ ÂÎÂÍÚÓÏËÓ„‡ÙËflÚ‡ ÒÂ ÛÒÚ‡ÌÓ-‚fl‚‡Ú ‰‡ÌÌË Á‡ Ì‡Ï‡ÎÂÌËÂ Ì‡ ‡ÏÔÎËÚÛ‰ËÚÂ Ì‡ ÒÛÏ‡ÌËÚÂÏÓÚÓÌË ‡ÍˆËÓÌÌË ÔÓÚÂÌˆË‡ÎË (ëåÄè) Ë ÚÂÁË Ì‡ ÒÂ-ÚË‚ÌËÚÂ ÌÂ‚ÌË ‡ÍˆËÓÌÌË ÔÓÚÂÌˆË‡ÎË (ëçÄè). é·ËÍÌÓ-‚ÂÌÓ ÏÓÊÂ ‰‡ ÒÂ Â„ËÒÚË‡ Ë ÎÂÍÓ Á‡·‡‚flÌÂ Ì‡ ÒÍÓÓÒÚ-Ú‡ Ì‡ ÔÓ‚ÂÊ‰‡ÌÂ (ëè), ‰ËÒÚ‡ÎÌËÚÂ Î‡ÚÂÌˆËË ËÎË ÚÂÁËÌ‡ F-‚˙ÎÌËÚÂ. àÁÒÎÂ‰‚‡ÌÂÚÓ Ì‡ ÔÓ‚Ó‰ËÏÓÒÚÚ‡ ÔÓ ‰Ë‡Ù-‡„Ï‡ÎÌËÚÂ ÌÂ‚Ë ÏÓÊÂ ‰‡ Ò‚˙ÊÂ ‡Á‚ËÚËÂÚÓ Ì‡ ‰Ëı‡-ÚÂÎÌ‡Ú‡ ÒÎ‡·ÓÒÚ Ò ÔÓfl‚‡Ú‡ Ì‡ èäë (30). ìÒÚ‡ÌÓ‚ÂÌÓ Â,˜Â ÂÔÂÚËÚË‚Ì‡Ú‡ ÌÂ‚Ì‡ ÒÚËÏÛÎ‡ˆËfl ÌÂ ÔÓÍ‡Á‚‡ Ì‡Û-¯ÂÌËÂ Ì‡ ÌÂ‚ÌÓ-ÏÛÒÍÛÎÌÓÚÓ ÔÂ‰‡‚‡ÌÂ (6,7,33).

óÂÁ Ë„ÎÂÌ‡ ÖåÉ ÒÂ ÛÒÚ‡ÌÓ‚fl‚‡Ú ÔËÁÌ‡ˆË Ì‡ ‰ÂÌÂ‚‡-ˆËfl – Ó·ËÎÌË ÙË·ËÎÂÌË ÔÓÚÂÌˆË‡ÎË Ë ÔÓÎÓÊËÚÂÎÌËÓÒÚË ‚˙ÎÌË. óÂÒÚÓ ÒÂ ÓÚ‚ÂÊ‰‡Ú ÏËÓÚÓÌË˜ÌË ‡Áfl‰Ë ËÒÚ‡ÌÌË Á‡ÎÔÓ‚Â. ÑÂÌÂ‚‡ˆËflÚ‡ ÔË èäë ÒÂ Â„ËÒÚË‡‚ ÔÓ-Í˙ÒÂÌ ÂÚ‡Ô ÓÚ Ì‡˜‡ÎÓÚÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ, Í‡ÍÚÓ Âı‡‡ÍÚÂÌÓ Ë Á‡ ‰Û„Ë ÓÒÚË ÔÓÎËÌÂ‚ÓÔ‡ÚËË. Ç ‡ÁÎË˜-Ì‡ ÒÚÂÔÂÌ Â Ì‡Ï‡ÎÂÌ ·Ófl Ì‡ ‡ÍˆËÓÌÌËÚÂ ÔÓÚÂÌˆË‡ÎË ËÌflÍÓË ÓÚ Úflı ËÏ‡Ú ı‡‡ÍÚÂËÒÚËÍË Ì‡ ,,ÏËÓ„ÂÌÌË”.óÂÁ ÒÚËÏÛÎ‡ˆËÓÌÌ‡ ÂÎÂÍÚÓÏËÓ„‡ÙËfl Ì‡ Â‰ËÌË˜ÌÓÏÛÒÍÛÎÌÓ ‚Î‡ÍÌÓ Â ‰ÓÍ‡Á‡Ì‡ ‰ËÒÙÛÌÍˆËfl Ì‡ ‡ÍÒÓÌÌËÚÂÚÂÏËÌ‡ÎË, ÍÓÂÚÓ ÒÔÓÂ‰ ‡‚ÚÓËÚÂ Ó·flÒÌfl‚‡ ÓÔËÒ‡Ì‡Ú‡ÂÎÂÍÚÓÏËÓ„‡ÙÒÍ‡ Í‡ÚËÌ‡ (27).

èÄíéåéêîéãéÉàóçà àáëãÖÑÇÄçàü

Ç ÔÓÛ˜‚‡ÌËfl ÔÓ‚Â‰ÂÌË ÓÚ Bolton Ë Ò˙‡‚ÚÓË (6, 33)Â ËÁ‚˙¯‚‡Ì‡ ·ËÓÔÒËfl Ì‡ ÔÓÍÒËÏ‡ÎÌË Ë ‰ËÒÚ‡ÎÌË ÏÓ-ÚÓÌË Ë ÒÂÚË‚ÌË ÌÂ‚ÌË ÒÂ„ÏÂÌÚË, Í‡ÍÚÓ Ë ·ËÓÔÒËfl Ì‡ÔÓÍÒËÏ‡ÎÌË Ë ‰ËÒÚ‡ÎÌË ÏÛÒÍÛÎË. ìÒÚ‡ÌÓ‚ÂÌË Ò‡ ‰‡ÌÌË Á‡ÔÂ‰ËÏÌÓ ‰ËÒÚ‡ÎÌ‡ ‡ÍÒÓÌ‡ÎÌ‡ ‰Â„ÂÌÂ‡ˆËfl Ì‡ ÔÂËÙÂÌË-ÚÂ ÌÂ‚Ë. ÑÓÍ‡Á‡Ì‡ Â ˆÂÌÚ‡ÎÌ‡ ıÓÏ‡ÚÓÎËÁ‡ Ì‡ ÔÂ‰ÌÓ-Ó„Ó‚ËÚÂ ÍÎÂÚÍË, Í‡ÍÚÓ Ë Á‡„Û·‡ Ì‡ ÌÂ‚ÓÌË ‚ ‰ÓÁ‡ÎÌË-ÚÂ „‡Ì„ÎËË. çÂ Ò‡ ÛÒÚ‡ÌÓ‚ÂÌË ‰‡ÌÌË Á‡ ‚˙ÁÔ‡ÎËÚÂÎÂÌ ÔÓ-ˆÂÒ Ì‡ ÔÂËÙÂÌ‡Ú‡ ÌÂ‚Ì‡ ÒËÒÚÂÏ‡. åÛÒÍÛÎÌ‡Ú‡ ·ËÓÔ-ÒËfl Â Ò ÍÓÌÒÚÂÎ‡ˆËfl Ì‡ ıÓÌË˜Ì‡ Ë ÓÒÚ‡ ‰ÂÌÂ‚‡ˆËfl ËÔÓ-fl‰ÍÓ Ò ı‡‡ÍÚÂ Ì‡ ÏËÓ„ÂÌÌË ÔÓÏÂÌË.

ÑàÄÉçéëíàóçà äêàíÖêàà áÄ èäë

Ç ÎËÚÂ‡ÚÛ‡Ú‡ Ò˙˘ÂÒÚ‚Û‚‡Ú ‰Ë‡„ÌÓÒÚË˜ÌË ÍËÚÂ-ËË, ÔÂ‰ÎÓÊÂÌË ÓÚ Bolton Ë Ò˙‡‚ÚÓË (4) Á‡ ‰Ë‡„ÌÓÒÚË-ˆË‡ÌÂ Ì‡ ÔÓÎËÌÂ‚ÓÔ‡ÚËfl ÔË ÍËÚË˜ÌË Ò˙ÒÚÓflÌËfl. èËËÁÔÓÎÁ‚‡ÌÂÚÓ Ì‡ ÚÂÁË ÍËÚÂËË Â ÌÂÓ·ıÓ‰ËÏÓ ËÁÍÎ˛˜‚‡-ÌÂ Ì‡ ‰Û„Ë ÔË˜ËÌË Á‡ ÓÒÚ‡ ‡ÍÒÓÌ‡ÎÌ‡ ÔÓÎËÌÂ‚ÓÔ‡ÚËfl(Ì‡Ô. Ú‡ÍË‚‡ ÔË ÚË‡ÏËÌÂÌ ‰ÂÙËˆËÚ, ÔÓÙËËfl Ë ‰):

1. äËÚË˜ÌÓ Ò˙ÒÚÓflÌËÂ Ì‡ Ô‡ˆËÂÌÚ‡ (ÒÂÔÒËÒ Ë ÏÛÎÚË-Ó„‡ÌÌ‡ ÌÂ‰ÓÒÚ‡Ú˙˜ÌÓÒÚ, ÒËÌ‰ÓÏ Ì‡ ÒËÒÚÂÏÌ‡‚˙ÁÔ‡ÎËÚÂÎÌ‡ Â‡ÍˆËfl);

2. á‡ÚÛ‰ÌÂÌÓ ËÎË ÌÂ‚˙ÁÏÓÊÌÓ ÒÔË‡ÌÂ Ì‡ ËÁÍÛÒÚ‚ÂÌ‡‡Ô‡‡ÚÌ‡ ‚ÂÌÚËÎ‡ˆËfl, (ÔË ËÁÍÎ˛˜ÂÌË ·ÂÎÓ‰Ó·ÌËË/ËÎË Ò˙‰Â˜ÌË ÔË˜ËÌË Á‡ ÚÓ‚‡);

3. Ç˙ÁÏÓÊÌ‡ ÒÎ‡·ÓÒÚ ‚ Í‡ÈÌËˆËÚÂ.4. ÖÎÂÍÚÓÏËÓ„‡ÙÒÍË ‰‡ÌÌË Á‡ ‡ÍÒÓÌ‡ÎÌ‡ ÏÓÚÓÌ‡ Ë

ÒÂÚË‚Ì‡ ÔÓÎËÌÂ‚ÓÔ‡ÚËfl.


ÑàîÖêÖçñàÄãçÄ ÑàÄÉçéáÄ

çÂÓ·ıÓ‰ËÏÓ Â ËÁÍÎ˛˜‚‡ÌÂ Ì‡ „ÓÎflÏ ·ÓÈ Á‡·ÓÎfl‚‡ÌËflÍ‡ÚÓ ÓÒÚ‡ ‡ÍÒÓÌ‡ÎÌ‡ ÏÓÚÓÌ‡ ÌÂ‚ÓÔ‡ÚËfl; ‡ÍÒÓÌ‡ÎÂÌ Ë‰ÂÏËÂÎËÌËÁË‡˘ ÚËÔ Ì‡ ÒËÌ‰ÓÏ‡ Ì‡ Guillain-Barre – ÔËÚÂÊÍË ÍÎËÌË˜ÌË ÙÓÏË Ì‡ ÔÓÚË˜‡ÌÂ, ËÁËÒÍ‚‡˘Ë ‡Ô‡‡Ú-Ì‡ ‚ÂÌÚËÎ‡ˆËfl. Ç‡ÊÌÓ Â ‰‡ ÒÂ ÓÚı‚˙ÎË ‡Á‚ËÚËÂ Ì‡ ÏÛÒ-ÍÛÎÌ‡ ÒÎ‡·ÓÒÚ ÒÎÂ‰ ËÁÔÓÎÁ‚‡ÌÂ Ì‡ ‚ËÒÓÍË ‰ÓÁË ÌÂ‚ÌÓ-ÏÛÒ-ÍÛÎÌË ·ÎÓÍÂË. Ç Ú‡ÍË‚‡ ÒÎÛ˜‡Ë ÂÔÂÚËÚË‚Ì‡Ú‡ ÌÂ‚Ì‡ÒÚËÏÛÎ‡ˆËfl ÏÓÊÂ ‰‡ ·˙‰Â ÔÓÎÂÁÌ‡ Á‡ ÔÓÒÚ‡‚flÌÂ Ì‡ ‰Ë‡„ÌÓ-Á‡Ú‡ (24). ífl·‚‡ ‰‡ ÒÂ ËÁÍÎ˛˜‡Ú Ë Ò˙ÒÚÓflÌËfl Ì‡ ÏËÓ„ÂÌ-Ì‡ Û‚Â‰‡ – ÏËÓÔ‡ÚËfl ÔË ÍËÚË˜ÌË Ò˙ÒÚÓflÌËfl, ‡·‰ÓÏË-ÓÎËÁ‡, ‰ËÙÛÁÌ‡ (Í‡ıÂÍÚË˜Ì‡) ÏËÓÔ‡ÚËfl, Í‡ÍÚÓ Ë Ò˙ÒÚÓfl-ÌËfl Ì‡ ÍÓÏ·ËÌË‡ÌÓ Û˜‡ÒÚËÂ Ì‡ ÔÂËÙÂÌËÚÂ ÌÂ‚Ë Ë ÏÛÒ-ÍÛÎÌ‡Ú‡ Ú˙Í‡Ì. ê‡ÁÎË˜ÌË ÏÓÌÓÌÂ‚ÓÔ‡ÚËË Ë ÔÎÂÍÒÓÔ‡ÚËËÏÓ„‡Ú ‰‡ ÒÂ ÔÓfl‚fl‚‡Ú ËÁÓÎË‡ÌÓ ËÎË Á‡Â‰ÌÓ Ò èäë Ë åèëÍ‡ÚÓ ÂÁÛÎÚ‡Ú Ì‡ ÌÂ‚Ì‡ ÍÓÏÔÂÒËfl, Ú˙È Í‡ÚÓ ÔÂËÙÂ-ÌËÚÂ ÌÂ‚Ë ÔË Ô‡ˆËÂÌÚË ‚ ÍËÚË˜ÌÓ Ò˙ÒÚÓflÌËÂ Ò‡ ÔÂ‰-‡ÁÔÓÎÓÊÂÌË Í˙Ï Ú‡‚Ï‡ÚË˜Ì‡ Û‚Â‰‡ (5).

åàéèÄíàü èêà äêàíàóçà ëöëíéüçàü

è˙‚Ë˜ÌÓÚÓ ÏÛÒÍÛÎÌÓ Á‡Òfl„‡ÌÂ Ò˙˘Ó ÏÓÊÂ ‰‡ ·˙‰ÂÔË˜ËÌ‡ Á‡ ‡Á‚ËÚËÂ Ì‡ ÒÎ‡·ÓÒÚ ‚ Í‡ÈÌËˆËÚÂ Ë Ì‡ ‰Ëı‡-ÚÂÎÌ‡ ÏÛÒÍÛÎ‡ÚÛ‡ ÔË Ô‡ˆËÂÌÚË ‚ ÍËÚË˜ÌÓ Ò˙ÒÚÓfl-ÌËÂ. åäë ÏÓÊÂ ‰‡ ÒÂ ÔÓfl‚Ë ÌÂÁ‡‚ËÒËÏÓ ËÎË ‚ Ò˙˜ÂÚ‡ÌËÂÒ èäë. è˙‚ËÚÂ ÒÎÛ˜‡Ë Ì‡ åäë Ò‡ Ò‚˙Á‡ÌË Ò ÔËÎ‡„‡ÌÂÌ‡ ‚ËÒÓÍË ‰ÓÁË ÍÓÚËÍÓÒÚÂÓË‰Ë Ë ÌÂ‚ÌÓ-ÏÛÒÍÛÎÌË ·ÎÓ-ÍÂË ÔË Ô‡ˆËÂÌÚË Ò ‡ÒÚÏ‡ÚË˜ÂÌ ÒÚ‡ÚÛÒ, ‡ ÔÓ-Í˙ÒÌÓåäë Â ÛÒÚ‡ÌÓ‚ÂÌ‡ ÒÎÂ‰ ˜ÂÌÓ‰Ó·ÌË Ú‡ÌÒÔÎ‡ÌÚ‡ˆËË(14) Ë ÔË ÒÎÛ˜‡Ë Ì‡ ÒÂÔÒËÒ Ò ÏÛÎÚËÓ„‡ÌÌ‡ ÌÂ‰ÓÒÚ‡Ú˙˜-ÌÓÒÚ (34).

KãàçàóçÄ äÄêíàçÄ

ï‡‡ÍÚÂÌË Ò‡ ‚flÎËÚÂ Ô‡ÂÁË Ì‡ Í‡ÈÌËˆËÚÂ Ë ÔÓ-fl‰-ÍÓ ‚˙‚ÎË˜‡ÌÂ Ì‡ ÎËˆÂ‚ËÚÂ ÏÛÒÍÛÎË Ë ÚÂÁË Ì‡ ‰Ë‡Ù‡„Ï‡Ú‡.çÂ Â ÛÒÚ‡ÌÓ‚ÂÌ‡ ÔÂ‰ËÎÂÍˆËfl Ì‡ Á‡Òfl„‡ÌÂ Ì‡ ÏÛÒÍÛÎËÚÂ –Â‰Ì‡Í‚Ó Ò‡ Á‡ÒÂ„Ì‡ÚË Í‡ÍÚÓ ÔÓÍÒËÏ‡ÎÌËÚÂ, Ú‡Í‡ Ë ‰ËÒ-Ú‡ÎÌË ÏÛÒÍÛÎÌË „ÛÔË. Ç ÎËÚÂ‡ÚÛ‡Ú‡ Ò‡ ÓÔËÒ‡ÌË Ë ÒÎÛ-˜‡Ë Ì‡ ‡Á‚ËÚËÂ Ì‡ ÒÎ‡·ÓÒÚ Ì‡ ÂÍÒÚ‡ÓÍÛÎ‡ÌËÚÂ ÏÛÒÍÛÎË‰Ó Ô˙ÎÌ‡ ÓÙÚ‡ÎÏÓÔÎÂ„Ëfl (14). ëÛıÓÊËÎÌÓ-Ì‡‰ÍÓÒÚÌËÚÂÂÙÎÂÍÒË Ò‡ ÒÌËÊÂÌË, ÌÓ ÏÓ„‡Ú ‰‡ ·˙‰‡Ú Ë Á‡Ô‡ÁÂÌË. á‡åäë ÌÂ Ò‡ ı‡‡ÍÚÂÌË ÏË‡Î„Ë˜ÌË ÓÔÎ‡Í‚‡ÌËfl.

ÖãÖäíêéåàéÉêÄîëäà àáëãÖÑÇÄçàü

ÖÎÂÍÚÓÌÂ‚Ó„‡ÙËflÚ‡ ‡ÁÍË‚‡ ‰‡ÌÌË Á‡ Ì‡Ï‡ÎÂÌË‡ÏÔÎËÚÛ‰Ë Ì‡ ëåÄè. ÄÏÔÎËÚÛ‰‡Ú‡ Ì‡ ÒÂÚË‚ÌËÚÂ ÔÓ-ÚÂÌˆË‡ÎË ÏÓÊÂ ‰‡ ·˙‰Â Á‡Ô‡ÁÂÌ‡, ÌÓ ‚ ÌflÍÓË ÒÎÛ˜‡Ë ÚflÏÓÊÂ ‰‡ ·˙‰Â ÒÌËÊÂÌ‡ ÔÓ‡‰Ë ‡Á‚ËÚËÂ Ì‡ ÔÂËÌÂ‚‡ÎÌËÓÚÓˆË. èË ËÁÒÎÂ‰‚‡ÌÂ Ì‡ Ô‡ˆËÂÌÚË Ò ÂÔÂÚËÚË‚Ì‡ ÌÂ‚-Ì‡ ÒÚËÏÛÎ‡ˆËfl Â ÛÒÚ‡ÌÓ‚ÂÌ ‰ÂÍÂÏÂÌÚ ÔË ˜‡ÒÚ ÓÚ Ô‡-ˆËÂÌÚËÚÂ (34).

èË Ë„ÎÂÌ‡ ÖåÉ ‚ ÔÓ‚Â˜ÂÚÓ ÒÎÛ˜‡Ë ÒÂ ÛÒÚ‡ÌÓ‚fl‚‡ ‰Â-ÌÂ‚‡ˆËfl – ÙË·ËÎÂÌË ÔÓÚÂÌˆË‡ÎË Ë ÔÓÎÓÊËÚÂÎÌË ÓÒÚ-Ë ‚˙ÎÌË ‚ ‰ËÒÚ‡ÎÌËÚÂ Ë ÔÓÍÒËÏ‡ÎÌË ÏÛÒÍÛÎË Ì‡ ˙ˆÂÚÂË Í‡Í‡Ú‡. èÓ‚ÂÊ‰‡ÌÂÚÓ Ì‡ ÖåÉ ˜ÂÒÚÓ Â Á‡ÚÛ‰ÌÂÌÓ‰Ó ÌÂ‚˙ÁÏÓÊÌÓ ÔÓ‡‰Ë Ò˙Ô˙ÚÒÚ‚‡˘‡ ÂÌˆÂÙ‡ÎÓÔ‡ÚËfl ËÎËÒÂ‰‡ˆËfl Ì‡ Ô‡ˆËÂÌÚ‡. éÚ‚ÂÊ‰‡Ú ÒÂ ÌËÒÍÓ‡ÏÔÎËÚÛ‰ÌË Ë ÒÌ‡Ï‡ÎÂÌ‡ ÔÓ‰˙ÎÊËÚÂÎÌÓÒÚ ‡ÍˆËÓÌÌË ÔÓÚÂÌˆË‡ÎË. äÓÎË-˜ÂÒÚ‚ÂÌ‡Ú‡ ÖåÉ ÔÓÚ‚˙Ê‰‡‚‡ ÏËÓ„ÂÌÂÌ ı‡‡ÍÚÂ Ì‡ÔÓÏÂÌËÚÂ ‚ ÔÓ‚Â˜ÂÚÓ ÓÚ ÒÎÛ˜‡ËÚÂ.

ãÄÅéêÄíéêçà à èÄíéåéêîéãéÉàóçà àáëãÖÑÇÄçàü

àÁÒÎÂ‰‚‡ÌÂÚÓ Ì‡ ÒÂÛÏÌ‡Ú‡ ÍÂ‡ÚËÌÍËÌ‡Á‡ ÏÓÊÂ ‰‡·˙‰Â ÔÓÎÂÁÌÓ Á‡ ˆÂÎËÚÂ Ì‡ ‰ËÙÂÂÌˆË‡ÎÌ‡Ú‡ ‰Ë‡„ÌÓÁ‡.áÌ‡˜ËÚÂÎÌÓ ÔÓ‚Ë¯ÂÌËÚÂ ÌË‚‡ Ò‡ ı‡‡ÍÚÂÌË Á‡ ÌÂÍÓ-

ÚËÁË‡˘‡Ú‡ ÏËÓÔ‡ÚËfl, ‰ÓÍ‡ÚÓ ÔË ‰Û„Ë ÚËÔÓ‚Â Ì‡åäë ÌË‚‡Ú‡ Ì‡ ÍÂ‡ÚËÌÍËÌ‡Á‡Ú‡ ÏÓ„‡Ú ‰‡ ·˙‰‡Ú Ò‡ÏÓÎÂÍÓ ÔÓ‚Ë¯ÂÌË (13).

åÛÒÍÛÎÌ‡Ú‡ ·ËÓÔÒËfl ‡ÁÍË‚‡ ‰‡ÌÌË Á‡ ‡ÚÓÙËfl ÔÓ-˜ÂÒÚÓ Ì‡ ÏÛÒÍÛÎÌË ‚Î‡ÍÌ‡ ÚËÔ 2, ÔÓ-fl‰ÍÓ Á‡ ‚Î‡ÍÌ‡ ÚËÔ1 ËÎË ‡ÚÓÙËfl Ì‡ ‚ÒË˜ÍË ÚËÔÓ‚Â ‚Î‡ÍÌ‡ (26). çÂ Ò‡ ı‡‡Í-ÚÂÌË ÌÂÍÓÚË˜ÌË Ë ‚‡ÍÛÓÎËÁË‡˘Ë ÔÓÏÂÌË ‚ ÏÛÒÍÛÎÌË-ÚÂ ‚Î‡ÍÌ‡. èË ÂÎÂÍÚÓÌÌ‡ ÏËÍÓÒÍÓÔËfl ÒÂ ÛÒÚ‡ÌÓ‚fl‚‡ËÁ·Ë‡ÚÂÎÌ‡ Á‡„Û·‡ Ì‡ ‰Â·ÂÎË (ÏËÓÁËÌÓ‚Ë) ‚Î‡ÍÌ‡ (11, 23).

ÑàÄÉçéëíàóçà äêàíÖêàà áÄ åäë

èÂ‰ÎÓÊÂÌË Ò‡ ÓÚ Lacomis Ë Ò˙‡‚ÚÓË ÔÂÁ 2000 „Ó‰Ë-Ì‡ (16). ëÔÓÂ‰ ‡‚ÚÓËÚÂ Á‡ ÔÓÒÚ‡‚flÌÂ Ì‡ ÒË„ÛÌ‡ ‰Ë‡„-ÌÓÁ‡ Â ÌÂÓ·ıÓ‰ËÏÓ ËÁÔ˙ÎÌÂÌËÂ Ì‡ Ô˙‚ËÚÂ ÔÂÚ ÍËÚÂËfl:

1. AÏÔÎËÚÛ‰ËÚÂ Ì‡ ëçÄè Ò‡ Á‡Ô‡ÁÂÌË Ì‡‰ 80% ÓÚ‰ÓÎÌ‡Ú‡ „‡ÌËˆ‡ Ì‡ ÌÓÏ‡Ú‡;

2. èË Ë„ÎÂÌ‡ ÖåÉ – Â„ËÒÚË‡ÌÂ Ì‡ ‡ÍˆËÓÌÌË ÔÓÚÂÌ-ˆË‡ÎË Ò Í˙Ò‡ ÔÓ‰˙ÎÊËÚÂÎÌÓÒÚ Ë ÌËÒÍË ‡ÏÔÎËÚÛ‰Ë,Ò ‡ÌÌÓ ËÎË ÌÓÏ‡ÎÌÓ Ì‡ÒË˘‡ÌÂ Ì‡ Á‡ÔËÒ‡, Ò ËÎË ·ÂÁÂ„ËÒÚË‡ÌÂ Ì‡ ÙË·ËÎÂË ‡ÍˆËÓÌÌË ÔÓÚÂÌˆË‡ÎË;

3. éÚÒ˙ÒÚ‚ËÂ Ì‡ ‰ÂÍÂÏÂÌÚ ÔË ÂÔÂÚËÚË‚Ì‡ ÌÂ‚Ì‡ÒÚËÏÛÎ‡ˆËfl

4. åÛÒÍÛÎÌ‡ Ô‡ÚÓÏÓÙÓÎÓ„Ë˜Ì‡ Ì‡ıÓ‰Í‡ Á‡ ÏËÓÔ‡ÚËflÒ˙Ò Á‡„Û·‡ Ì‡ ÏËÓÁËÌ;

5. èÓÌËÊÂÌË ‡ÏÔÎËÚÛ‰Ë Ì‡ ëåÄè Ò ÔÓ-Ï‡ÎÍÓ ÓÚ 80%ÓÚ ‰ÓÎÌ‡Ú‡ „‡ÌËˆ‡ Ì‡ ÌÓÏ‡Ú‡ ‚ ‰‚‡ ËÎË ÔÓ‚Â˜ÂÌÂ‚‡ ·ÂÁ ·ÎÓÍ ‚ ÔÓ‚Ó‰ËÏÓÒÚÚ‡;

6. èÓ‚Ë¯ÂÌË ÌË‚‡ Ì‡ ÒÂÛÏÌ‡ ÍÂ‡ÚËÌÍËÌ‡Á‡7. ÑÂÏÓÌÒÚ‡ˆËfl Ì‡ ÏÛÒÍÛÎÌ‡ ÌÂ‚˙Á·Û‰ËÏÓÒÚ

èäë à åäë – ÑàîÖêÖçñàÄãçÄ ÑàÄÉçéáÄ

èÓ ÓÚÌÓ¯ÂÌËÂ Ì‡ ÔÂ‰¯ÂÒÚ‚‡˘ËÚÂ Ò˙ÒÚÓflÌËfl Ë ‰‚Â-ÚÂ ÛÒÎÓÊÌÂÌËfl ÏÓ„‡Ú ‰‡ ÒÂ ‡Á‚ËflÚ Ì‡ ÙÓÌ‡ Ì‡ ÒÂÔÚË˜ÌÓÒ˙ÒÚÓflÌËÂ Ë ÏÛÎÚËÓ„‡ÌÌ‡ ÌÂ‰ÓÒÚ‡Ú˙˜ÌÓÒÚ. ÇÒÂ Ô‡Íèäë Â Ì‡·Î˛‰‡‚‡Ì‡ ÔÓ-˜ÂÒÚÓ ÔË ÒÂÔÒËÒ, ‰ÓÍ‡ÚÓ åäë ÂÒ‚˙Á‚‡Ì‡ ÔÓ-˜ÂÒÚÓ Ò ÎÂ˜ÂÌËÂ Ì‡ ‡ÒÚÏ‡ÚË˜ÂÌ ÒÚ‡ÚÛÒ.Ñ‚ÂÚÂ Á‡·ÓÎfl‚‡ÌËfl ÔÓ-ÚÛ‰ÌÓ ÒÂ ÓÚ‰ËÙÂÂÌˆË‡Ú ÔÓÍÎËÌË˜Ì‡Ú‡ ÒË Í‡ÚËÌ‡, Ú˙È Í‡ÚÓ Ë ‚ ‰‚‡Ú‡ ÒÎÛ˜‡fl ÒÂÛÒÚ‡ÌÓ‚fl‚‡ ÒÎ‡·ÓÒÚ ‚ ˜ÂÚËËÚÂ Í‡ÈÌËÍ‡, ÍÓflÚÓ Ó·‡˜ÂÏÓÊÂ ‰‡ ·˙‰Â ÔÓ-ËÁ‡ÁÂÌ‡ ‚ ‰ËÒÚ‡ÎÌËÚÂ ÓÚ‰ÂÎË Ì‡ Í‡È-ÌËˆËÚÂ ÔË èäë, Á‡ ‡ÁÎËÍ‡ ÓÚ åäë, ÔË ÍÓflÚÓ ÒÎ‡·Ó-ÒÚÚ‡ Â ‡‚ÌÓÏÂÌÓ ‡ÁÔÂ‰ÂÎÂÌ‡. éÚÎË˜ËÚÂÎÌ‡ ˜ÂÚ‡ Á‡åäë Â Ë ÔÓ-˜ÂÒÚÓ Â„ËÒÚË‡ÌÂ Ì‡ ÒÎ‡·ÓÒÚ Ì‡ ÂÍÒÚ‡Ó-ÍÛÎ‡Ì‡Ú‡ Ë ÎËˆÂ‚‡ ÏÛÒÍÛÎ‡ÚÛ‡.

èÓ ÓÚÌÓ¯ÂÌËÂ Ì‡ ÔÓ‚ÓÍË‡˘ËÚÂ ÎÂÍ‡ÒÚ‚ÂÌË ÒÂ‰-ÒÚ‚‡ ‚ÒÂ Ó˘Â ‚ ÎËÚÂ‡ÚÛ‡Ú‡ ÌÂ Ò‡ ÛÒÚ‡ÌÓ‚ÂÌË ÒË„ÛÌË‰‡ÌÌË Á‡ ÚÓ‚‡ ‰‡ÎË ÔÂ‰¯ÂÒÚ‚‡˘Ó ÎÂ˜ÂÌËÂ Ò ÍÓÚËÍÓÒ-ÚÂÓË‰Ë Ë ÌÂ‚ÌÓ-ÏÛÒÍÛÎÌË ·ÎÓÍÂË ÔÂ‰‡ÁÔÓÎ‡„‡ ÔÓ‚Â-˜Â Á‡ ‡Á‚ËÚËÂ Ì‡ åäë, ÓÚÍÓÎÍÓÚÓ Á‡ èäë. ÇÒÂ Ô‡Í ‰Ó-ÒÂ„‡ ÌÂ Ò‡ ÓÔËÒ‡ÌË ÒÎÛ˜‡Ë Ì‡ ÔÓfl‚‡ Ì‡ èäë ÒÎÂ‰ ËÁÔÓÎÁ‚‡-ÌÂ Ì‡ Ú‡Í˙‚ ‚Ë‰ ÎÂ˜ÂÌËÂ.

çÂ Â ÎÂÒÌÓ ‡Á„‡ÌË˜‡‚‡ÌÂÚÓ Ì‡ ‰‚ÂÚÂ Á‡·ÓÎfl‚‡ÌËfl Ë˜ÂÁ ÂÁÛÎÚ‡ÚËÚÂ, ÔÓÎÛ˜ÂÌË ÓÚ ÂÎÂÍÚÓÏËÓ„‡ÙÒÍËÚÂËÁÒÎÂ‰‚‡ÌËfl. à ÔË ‰‚ÂÚÂ Ò˙ÒÚÓflÌËfl ÒÂ ÛÒÚ‡ÌÓ‚fl‚‡ÚÌËÒÍË ‡ÏÔÎËÚÛ‰Ë Ì‡ ëåÄè. èË „ÓÎflÏ‡ ˜‡ÒÚ ÓÚ Ô‡ˆËÂÌ-ÚËÚÂ Ò åäë ÒÂ Â„ËÒÚË‡Ú Ò˙˘Ó Ë ÒÌËÊÂÌË ‡ÏÔÎËÚÛ-‰Ë Ì‡ ëçÄè, ‚˙ÔÂÍË, ˜Â ÚÓ‚‡ ÒÂ ‰˙ÎÊË Ì‡ ‡Á‚ËÚËÂÚÓÌ‡ Ú˙Í‡ÌÌË ÓÚÓˆË. è‡ÍÚË˜ÂÒÍË ÔÂˆÂÌÍ‡Ú‡ Ì‡ ‡·ÌÓ-ÏËÚÂ ÓÚÍÎÓÌÂÌËfl Ì‡ ëçÄè ˜ÂÒÚÓ Ô˙ÚË Â ÒËÎÌÓ Á‡ÚÛ‰-ÌÂÌ‡. çÂ Ì‡ ÔÓÒÎÂ‰ÌÓ ÏflÒÚÓ Á‡ÚÛ‰ÌÂÌËflÚ‡ Ë‰‚‡Ú Ë ÓÚÔÓ‚ÂÊ‰‡ÌÂ Ì‡ ÂÎÂÍÚÓÏËÓ„‡ÙÒÍÓÚÓ ËÁÒÎÂ‰‚‡ÌÂ, ÍÓÂÚÓÛÒÚ‡ÌÓ‚fl‚‡ ‡ÍˆËÓÌÌË ÔÓÚÂÌˆË‡ÎË Ò ÌËÒÍË ‡ÏÔÎËÚÛ‰Ë ËÌ‡Ï‡ÎÂÌ‡ ÔÓ‰˙ÎÊËÚÂÎÌÓÒÚ, Í‡ÍÚÓ ÔË ÏËÓ„ÂÌÌËÚÂ, Ú‡-Í‡ Ë ÔË ÚÂÊÍËÚÂ ÌÂ‚Ó„ÂÌÌË ÔÓÏÂÌË. íÂÓÂÚË˜ÌÓ ‡Á„-‡ÌË˜‡‚‡ÌÂÚÓ Ì‡ ‰‚ÂÚÂ Á‡·ÓÎfl‚‡ÌËfl ÏÓÊÂ ‰‡ ÒÂ Ì‡Ô‡‚ËÔÓ Ô‡ÚÂÌ‡ Ì‡ Ì‡ÒË˘‡ÌÂ Ì‡ Á‡ÔËÒ‡ – Â‰ÛˆË‡Ì ÔË ÌÂ‚Ó-


„ÂÌÂÌ ÔÓˆÂÒ Ë ·˙ÁÓ Ì‡ÒË˘‡ÌÂ ÔË ÏËÓ„ÂÌÂÌ ÔÓˆÂÒ.ìÚÂÊÌfl‚‡˘ Ù‡ÍÚÓ Á‡ ÔÂˆÂÌÍ‡ Ì‡ ‚Ë‰‡ ÛÒÎÓÊÂÌÌËÂ ÔËÍËÚË˜ÌË Ò˙ÒÚÓflÌËfl Â Ó·ËÍÌÓ‚ÂÌÓ Ì‡ÒÎÓÊÂÌ‡Ú‡ ÂÌˆÂÙ‡-ÎÓÔ‡ÚËfl, ÍÓÂÚÓ Â Ò‚˙Á‡ÌÓ Ò ÏËÌËÏ‡ÎÌ‡ ËÎË ÔÓ˜ÚË ÎËÔÒ-‚‡˘‡ ‚ÓÎÂ‚‡ ÏÛÒÍÛÎÌ‡ ‡ÍÚË‚ÌÓÒÚ.

êË˜ Ë Ò˙‡‚ÚÓË ÔÂ‰Î‡„‡Ú ÏÂÚÓ‰ Á‡ Ì‡‰ÂÊ‰ÌÓ ‡Á„‡-ÌË˜‡‚‡ÌÂ Ì‡ ‰‚ÂÚÂ Á‡·ÓÎfl‚‡ÌËfl ˜ÂÁ ËÁÔÓÎÁ‚‡ÌÂ Ì‡ ‰ËÂÍÚÌ‡ ÏÛÒÍÛÎÌ‡ ÒÚËÏÛÎ‡ˆËfl (21,22). ëÔÓÂ‰ ÚflıÌ‡Ú‡ıËÔÓÚÂÁ‡ Ì‡Ï‡ÎÂÌËÂÚÓ Ì‡ ‡ÏÔÎËÚÛ‰‡Ú‡ Ì‡ ëåÄè ÔË Ô‡-ˆËÂÌÚË Ò åäë ÒÂ ‰˙ÎÊË Ì‡ Á‡„Û·‡ Ì‡ ‚˙Á·Û‰ËÏÓÒÚÚ‡ Ì‡ÏÛÒÍÛÎÌ‡Ú‡ ÏÂÏ·‡Ì‡. óÂÁ ÚÓÁË ÏÂÚÓ‰ ÔË åäë Ò‡ Â„Ë-ÒÚË‡ÌË ëåÄè Ò ÔÓÌËÊÂÌ‡ ‡ÏÔÎËÚÛ‰‡ ËÎË ÎËÔÒ‚‡˘Ë ÔËÒÚËÏÛÎË‡ÌÂ Ì‡ ÌÂ‚‡ Ë ÏÛÒÍÛÎ‡, ‰ÓÍ‡ÚÓ ÔË èäë ÒÂ ÔÓÎÛ-˜‡‚‡ ëåÄè Ò ÌÓÏ‡ÎÌ‡ ‡ÏÔÎËÚÛ‰‡ ÔË ÒÚËÏÛÎË‡ÌÂ Ì‡ÏÛÒÍÛÎ‡ Ë Ò Ì‡Ï‡ÎÂÌ‡ ‡ÏÔÎËÚÛ‰‡ - ÔË ÒÚËÏÛÎË‡ÌÂ Ì‡ ÌÂ-‚‡. íÂÒÚ˙Ú ËÏ‡ „ÓÎflÏÓ ÁÌ‡˜ÂÌËÂ ÔË Ô‡ˆËÂÌÚË Ò ÍÓÎË˜ÂÒÚ-‚ÂÌË Ì‡Û¯ÂÌËfl Ì‡ Ò˙ÁÌ‡ÌËÂÚÓ - ÓÚÒ˙ÒÚ‚ËÂ Ì‡ ‚ÓÎÂ‚‡ ÏÛÒ-ÍÛÎÌ‡ ‡ÍÚË‚ÌÓÒÚ. Ç˙ÔÂÍË ÚÓ‚‡ ÚÓÁË ÏÂÚÓ‰ ÌÂ Â ÔÓÎÛ˜ËÎ¯ËÓÍÓ ÔËÎÓÊÂÌËÂ ‚ ÍÎËÌË˜Ì‡Ú‡ Ô‡ÍÚËÍ‡, ÔÓ‡‰Ë ÚÂı-ÌË˜ÂÒÍË Á‡ÚÛ‰ÌÂÌËfl, Ò‚˙Á‡ÌË Ò ÂÎÂÍÚÓ‰ËÚÂ.

ç‡Í‡fl Úfl·‚‡ ‰‡ ÒÂ ÓÚ·ÂÎÂÊË, ˜Â Â ‚˙ÁÏÓÊÌÓ Ë Ò˙˜Â-Ú‡ÌËÂ Ì‡ èäë Ë åäë. Ç ÔÓÛ˜‚‡ÌÂ Ì‡ De JÓnghe Ë Ò˙‡‚ÚÓ-Ë (9) Ò‡ ËÁÒÎÂ‰‚‡ÌË 22 Ô‡ˆËÂÌÚ‡, ÔË ÍÓËÚÓ ÂÎÂÍÚÓÏËÓ„-‡ÙÒÍËÚÂ ËÁÒÎÂ‰‚‡ÌËfl ÔÓÍ‡Á‚‡Ú ‰‡ÌÌË Á‡ ‡ÍÒÓÌ‡ÎÌ‡ ÒÂÚË‚-ÌÓ-ÏÓÚÓÌ‡ ÔÓÎËÌÂ‚ÓÔ‡ÚËfl, ‡ ÔË 10 ÓÚ ÚÂÁË Ô‡ˆËÂÌÚËÏÛÒÍÛÎÌ‡Ú‡ ·ËÓÔÒËfl ‡ÁÍË‚‡ ‰‡ÌÌË Á‡ ÍÓÏ·ËÌ‡ˆËfl Ì‡ ÌÂ‚-Ó„ÂÌÌ‡ ‡ÚÓÙËfl Ò Ô˙‚Ë˜ÌÓ ÏËÓ„ÂÌÌË ÔÓÏÂÌË. èË Ò˙˜Â-Ú‡ÌËÂ Ì‡ èäë Ë åäë Ó·ËÍÌÓ‚ÂÌÓ ÏÛÒÍÛÎÌ‡Ú‡ ÒÎ‡·ÓÒÚ ÂÌ‡È-ÚÂÊÍÓ ËÁ‡ÁÂÌ‡. äÓ„‡ÚÓ Ò‡ Ì‡ÎËˆÂ ÍÎËÌË˜ÌË Ë ÖåÉ‰‡ÌÌË Á‡ ÔÂ‰ËÏÌÓ ÏÛÒÍÛÎÌÓ Á‡Òfl„‡ÌÂ, ÚÓ„‡‚‡ ÒÂÛÏÌËÚÂÌË‚‡ Ì‡ ÍÂ‡ÚËÌÍËÌ‡Á‡Ú‡ Ò‡ ÔÓ‚Ë¯ÂÌË, ÌÓ ÏÛÒÍÛÎÌ‡Ú‡ ·Ë-ÓÔÒËfl Â ÌÓÏ‡ÎÌ‡, ÔÓ„ÌÓÁ‡Ú‡ Â ÔÓ-‰Ó·‡, Ò ÔÓ-·˙ÁÓ‚˙ÁÒÚ‡ÌÓ‚fl‚‡ÌÂ Ì‡ Ô‡ˆËÂÌÚ‡. Ç ÒÎÛ˜‡ËÚÂ ÍÓ„‡ÚÓ Ò‡ Ì‡ÎË-ˆÂ ÍÎËÌË˜ÌË Ë ÖåÉ ‰‡ÌÌË Á‡ ÚÂÊÍÓ Á‡Òfl„‡ÌÂ Í‡ÍÚÓ Ì‡ ÌÂ-‚ËÚÂ, Ú‡Í‡ Ë Ì‡ ÏÛÒÍÛÎËÚÂ, ÒÂ Â„ËÒÚË‡Ú ‚ËÒÓÍË ÌË‚‡Ì‡ ÍÂ‡ÚËÌÍËÌ‡Á‡Ú‡, ÏËÓ„ÎÓ·ËÌÛËfl Ë ÌÂÍÓÁ‡ Ì‡ ÏÛÒÍÛÎ‡.èÓ„ÌÓÁ‡Ú‡ ÔË ÚÂÁË Ô‡ˆËÂÌÚË Â ÎÓ¯‡. (8).

áÄäãûóÖçàÖ

èÓÎËÌÂ‚ÓÔ‡ÚËflÚ‡ Ë ÏËÓÔ‡ÚËflÚ‡ ÔË ÍËÚË˜ÌË Ò˙Ò-ÚÓflÌËfl ÔÂ‰ÒÚ‡‚Îfl‚‡Ú ‚‡ÊÌË ÛÒÎÓÊÌÂÌËfl, ÍÓËÚÓ ÒÂ ‡Á-‚Ë‚‡Ú ÔÓ ‚ÂÏÂ Ì‡ ÔÓ‰˙ÎÊËÚÂÎÌ‡ àÅÇ Ë ‚Ó‰flÚ ‰Ó ‚ÎÓ-¯‡‚‡ÌÂ ‚ Ò˙ÒÚÓflÌËÂÚÓ Ì‡ Ô‡ˆËÂÌÚ‡. Ñ‚ÂÚÂ Á‡·ÓÎfl‚‡ÌËflÒÂ ÔÂÔÓÍË‚‡Ú ‚ ÁÌ‡˜ËÚÂÎÌ‡ ÒÚÂÔÂÌ ÔÓ Ò‚ÓflÚ‡ ÍÎËÌË˜-Ì‡ Ë ÂÎÂÍÚÓÏËÓ„‡ÙÒÍ‡ Í‡ÚËÌ‡, ˜ÂÒÚÓ Ò‡ Á‡Â‰ÌÓ ÔÂ‰Ò-Ú‡‚ÂÌË Ë ÚflıÌÓÚÓ ‡ÌÌÓ ‰Ë‡„ÌÓÒÚËˆË‡ÌÂ Ë ÓÔËÚ Á‡‡Á„‡ÌË˜‡‚‡ÌÂ ËÏ‡ Ó„ÓÏÌÓ ÁÌ‡˜ÂÌËÂ Á‡ Í‡ÈÌËfl ËÁıÓ‰ Ì‡Ô‡ˆËÂÌÚË, ÎÂÍÛ‚‡ÌË ‚ ËÌÚÂÌÁË‚ÌËÚÂ ÓÚ‰ÂÎÂÌËfl.

ãàíÖêÄíìêÄ1. Barohn, R.J., Jackson, C.E., Rogers, L.W., et al. Prolonged paralysis due to

nondepolarizing neuromuscular blocking agents and corticosteroids. MuscleNerve, 1994, 17, 647 – 654.

2. Bolton, C., Brown, J., Sibbald, W. The electrophysiologic investigation ofrespiratory paralysis in critically ill patients. Neurology, 1983, 33, 186.

3. Bolton, C.F, Young, G.B. Sepsis and septic shock: central and peripheralnervous systems. In: Sibbald WJ, Sprung CL, editors. New horizons: per-spectives on sepsis and septic shock. Fullerton: Society of Critical CareMedicine, 1986, 157 – 171.

4. Bolton, C.F. Critical illness polyneuropathy. In: Noseworthy JH, editor.Neurological therapeutics. London: Martin Dunitz, 2003, 2229 – 2236.

5. Bolton, C.F. Neuromuscular manifestations of critical illness. Muscle Nerve,2005, 32, 140-163.

6. Bolton, C.F., Gilbert, J.J., Hahn, A.F., Sibbald, W.J. Polyneuropathy in criti-cally ill patients. J Neurol, Neurosurg Psychiatry, 1984, 47, 1223-1231.

7. Bolton, C.F., Laverty, D.H., Brown, J.D., et al. Critically ill polyneuropathy:electrophysiological studies and differentiation from Guillain-Barre syn-drome. J Neurol Neurosurg Psychiatry, 1986, 49, 563-573.

8. Bolton, C.F., Ramsay, D.A., Rutledge, F. Acute quadriplegic myopathy(AQM), sepsis and the systemic inflammatory response syndrome (SIRS).Neurology, 1998, 50, 242-243.

9. De JÓnghe, B., Sharshar, T., Lefaucheur, J.P., et al. Paresis acquired in theintensive care unit: a prospective multicenter study. JAMA, 2002, 288, 2859-2867.

10. Erbsloh, F. Polyneuropatic pathological conditions in internal medicine.Munch Med Wochenschr, 1955, 97, 753-756.

11. Faragher, M.W., Day, B.J., Dennett, X. Critical care myopathy: an electro-physiological and histological study. Muscle Nerve, 1996, 19, 516 – 518.

12. Giostra, E., Magistris, M.R., Pizzolato, G., et al. Neuromuscular disorder inintensive care unit patients treated with pancuronium bromide. Occurrence ina cluster group of seven patients and two sporadic cases, with electrophysio-logic and histologic examination. Chest, 1994, 106, 210 – 220.

13. Hanson, P., Dive, A., Brucher, J.M., et al. Acute corticosteroid myopathy inintensive care patients. Muscle Nerve, 1997, 20, 1371-1380.

14. Lacomis, D., Giuliani, M.J., Van Cott. A., et al. Acute myopathy of intensivecare: clinical, electromyographic and pathological aspects. Ann Neurol, 1996,40, 645-654.

15. Lacomis, D., Smith, T.W., Chad, D.A. Acute myopathy and neuropathy instatus asthmaticus: case report and literature review. Muscle Nerve, 1993, 16,84 – 90.

16. Lacomis, D., Zochodne, D.W., Bird, S.J. Critical illness myopathy. MuscleNerve, 2000, 23, 1785-1788.

17. MacFarlene, I.A., Rosenthal, F.D. Severe myopathy after status asthmaticus.Lancet, 1977, II, 615.

18. Mertens, H.G. Disseminated neuropathy following coma. On the differenta-tion of so-called toxic polyneuropathy. Nervenarzt. 1961, 32, 71-79.

19. Op de Coul, A.A., Lambregts, P.C., Koeman, J, et al. Neuromuscular compli-cations in patients given Pavulon (pancuronium bromide) during artificialventilation. Clin Neurol Neurosurg, 1985, 87, 17 – 22.

20. Osler, W. The principles and practice of medicine. NewYork: D Appleton,1892.

21. M.., Teener, J., Raps, et al. Muscle is electrically inexitable in acute quadri-plegic myopathy. Neurology, 1996, 46, 731-73.

22. Rich, M.M., Bird, S.J., Raps, E.C., et al. Direct muscle stimulation in acutequadriplegic myopathy. Muscle Nerve, 1997, 20, 665-673.

23. Sander, H.W., Golden, M., Danon, M.J. Quadriplegic areflexic ICU illness:selective thick filament loss and normal nerve histology. Muscle Nerve, 2002,26, 499 – 505.

24. Segredo, V., Caldwell, J.E., Matthay, et al. Persistent paralysis in critically illpatients after long-term administration of vecuronium. N Engl J Med, 1992,327, 524-528.

25. Sher, J.H., Shafiq, S.A. Schutta, H.S. Acute myopathy with selective lysis ofmyosin filaments. Neurology, 1979, 29, 100 – 106.

26. Showalter, C.J., Engel, A.G. Acute quadriplegic myopathy: analysis ofmyosin isoforms and evidence of calpalin-mediated proteolysis. MuscleNerve, 1997, 20, 316-322.

27. Swartz, J., Planck, J., Briegel, J., Straube, A. Single-fiber electromyography,nerve conduction studies, and conventional electromyography in patients withcritical illness polyneuropathy: evidence for a lesion of terminal motor axons.Muscle Nerve, 1997, 20, 696-701.

28. Wijdicks, E.F, Litchy, W.J., Harrison, B.A., et al. The clinical spectrum ofcritical illness polyneuropathy. Mayo Clin Proc, 1994, 69, 955 – 959.

29. Witt, N.J, Zochodne, D.W., Bolton, C.F., et al. Peripheral nerve function insepsis and multiple organ failure. Chest, 1991, 99, 176 – 184.

30. Zifko, U.A., Zipko, H.T., Bolton, C.F. Clinical and electrophysiological find-ings in critical illness polyneuropathy. J Nuerol Sci, 1998, 159,186-193.

31. Zochodne, D.A., Bolton, C.F., Thompson, R.T., et al. Myopathy in critical ill-ness. Muscle Nerve, 1986, 9, 652.

32. Zochodne, D.W, Bolton, C.F., Laverty, D.A., et al. The effects of sepsis andmuscle function: an electrophysiologic and P-31 NMR study.Electroencephalogr Clin Neurophysiol, 1987, 66, 115 – 165.

33. Zochodne, D.W., Bolton, C.F., Wells, G.A., et al. Critical illness polyneu-ropathy. A complication of sepsis and multiple organ failure. Brain, 1987,110, 819-841.

34. Zochodne, D.W., Ramsay, D.A., Saly, V., et al. Acute necrotizing myopathy ofintensive care: electrophysiological studies. Muscle Nerve, 1994, 17, 285-292.

Ä‰ÂÒ Á‡ ÍÓÂÒÔÓÌ‰ÂÌˆËfl:

ÑÓˆ. åËÎÂÌ‡ åËÎ‡ÌÓ‚‡, ‰ÏìåÅÄã “ñ‡Ëˆ‡ âÓ‡ÌÌ‡ - àëìã”äÎËÌËÍ‡ ÔÓ ÌÂ‚ÓÎÓ„ËflëÓÙËfl, 1527ìÎ. ÅflÎÓ ÏÓÂ 8íÂÎ: 02 94 32 214e-mail: milanova_m@dir.


SUMMARY

TREATMENT OF PATIENTS WITH MALIGNANTSTROKE WITH DECOMPRESSIVE CRANIAL SURGERY

E. Vavrek, S. Isakov, D. Atanasova, M. MilanovaThe decompressive (external) cerebral surgery is one of

few surgical methods in neurology, proven by randomized tri-als. It is used in patients suffering from malignant cerebralinfarct. A cerebral oedema with lateral shift develops in suchpatients. These patients have a bad prognosis – about 80%mortality – if they undergo a conservative treatment. The cra-nial decompression should be performed as early as possible.The criteria for this intervention are improving constantly.The criteria of the published clinical trials should be used inthe clinical practice.

KEY WORDS: Malignant stroke, decompressive cranialsurgery.

êÖáûåÖ

ÑÂÍÓÏÔÂÒË‚Ì‡Ú‡ (‚˙Ì¯Ì‡) ÏÓÁ˙˜Ì‡ ıËÛ„Ëfl Â Â‰ËÌÓÚ Ï‡ÎÍÓÚÓ ‰ÓÍ‡Á‡ÌË Ò ‡Ì‰ÓÏËÁË‡ÌË ÔÓÛ˜‚‡ÌËfl ÓÔÂ-‡ÚË‚ÂÌ ÏÂÚÓ‰ Ì‡ ÎÂ˜ÂÌËÂ ‚ ÌÂ‚ÓÎÓ„ËflÚ‡. èËÎ‡„‡ ÒÂÔË Ô‡ˆËÂÌÚË Ò Ï‡ÎË„ÌÂÌ ÏÓÁ˙˜ÂÌ ËÌÙ‡ÍÚ. íÓ‚‡ Ò‡ Ô‡ˆË-ÂÌÚË, ÔË ÍÓËÚÓ ÒÂ ‡Á‚Ë‚‡ ËÁ‡ÁÂÌ ÏÓÁ˙˜ÂÌ ÓÚÓÍ Ò ‰ËÒ-ÎÓÍ‡ˆËfl Ë ÍÓËÚÓ ÔË ÍÓÌÒÂ‚‡ÚË‚ÌÓ ÎÂ˜ÂÌËÂ ËÏ‡Ú ÎÓ¯‡ÔÓ„ÌÓÁ‡ – ÒÏ˙ÚÌÓÒÚ ‰Ó 80%. ÑÂÍÓÏÔÂÒË‚Ì‡Ú‡ ıËÛ-

„Ëfl ÒÂ Ò˙ÒÚÓË ‚ ÓÚÒÚ‡Ìfl‚‡ÌÂ Ì‡ ÍÓÒÚÌÓ Î‡Ï·Ó Ë ÒÂ ÔË-Î‡„‡ ‚˙ÁÏÓÊÌÓ Ì‡È-‡ÌÓ. äËÚÂËËÚÂ Á‡ ÔÓ‚ÂÊ‰‡ÌÂÚÓÌ‡ Ú‡ÁË ıËÛ„Ë˜Ì‡ Ì‡ÏÂÒ‡ Ò‡ ‚ ÔÓˆÂÒ Ì‡ ÔÓÒÚÓflÌÌÓ ÔÓ-‰Ó·ÂÌËÂ, ÌÓ Á‡ ÒÂ„‡ ‚ ÍÎËÌË˜Ì‡Ú‡ Ô‡ÍÚËÍ‡ Â ÛÏÂÒÚÌÓ ‰‡ÒÂ ËÁÔÓÎÁ‚‡Ú ÍËÚÂËËÚÂ Ì‡ Á‡‚˙¯ËÎËÚÂ ÍÎËÌË˜ÌË ÔÓ-Û˜‚‡ÌËfl.

äãûóéÇà Ñìåà: å‡ÎË„ÌÂÌ ÏÓÁ˙˜ÂÌ ËÌÙ‡ÍÚ, ‰ÂÍÓÏÔÂÒË‚Ì‡ ıËÛ„Ëfl.

ÇöÇÖÑÖçàÖ

åÓÁ˙˜ÌËflÚ ËÌÒÛÎÚ Â Â‰ÌÓ ÓÚ Ì‡È-˜ÂÒÚËÚÂ Ë ÁÌ‡˜ËÏËÁ‡·ÓÎfl‚‡ÌËfl. Ç ÔÓÒÎÂ‰ÌËÚÂ „Ó‰ËÌË Á‡‚˙¯Ëı‡ ÌflÍÓË ÍÎË-ÌË˜ÌË ÔÓÛ˜‚‡ÌËfl ÛÒÚ‡ÌÓ‚fl‚‡˘Ë ÌÓ‚Ë ÏÂÚÓ‰Ë Ì‡ ÎÂ˜Â-ÌËÂ. èÂËÏÛ˘ÂÒÚ‚‡Ú‡ Ì‡ ÓÔÂ‡ÚË‚ÌËflÚ ÔÓ‰ıÓ‰ ·Â¯Â‰ÓÍ‡Á‡Ì ÓÚ Ó·Â‰ËÌÂÌËfl ‡Ì‡ÎËÁ Ì‡ ÔÓÛ˜‚‡ÌËflÚ‡ DES-TINY, DECIMAL Ë HAMLET ÔË ÌflÍÓË Ô‡ˆËÂÌÚË Ò àåà– ÓÔÂ‡ÚË‚Ì‡ ‰ÂÍÓÏÔÂÒË‚Ì‡ ıÂÏËÍ‡ÌËÂÍÚÓÏËfl ÔË Ô‡-ˆËÂÌÚË Ò Ú.Ì‡. Ï‡ÎË„ÌÂÌ ËÌÙ‡ÍÚ Ì‡ ÒÂ‰Ì‡ ÏÓÁ˙˜Ì‡ ‡-ÚÂËfl.

å‡ÎË„ÌÂÌËflÚ ËÌÙ‡ÍÚ Ì‡ ÒÂ‰Ì‡ ÏÓÁ˙˜Ì‡ ‡ÚÂËfl(åàëåÄ) ÒÂ ‰ÂÙËÌË‡ Ó·ËÍÌÓ‚ÂÌÓ Í‡ÚÓ Ó·¯ËÂÌ ËÌ-Ù‡ÍÚ Ì‡ ÒÂ‰Ì‡ ÏÓÁ˙˜Ì‡ ‡ÚÂËfl Ò ‚Ë‰ËÏ‡ Ì‡ ÒÍÂÌË„‡Ù-ÍÓ ËÁÒÎÂ‰‚‡ÌÂ ‰ËÒÎÓÍ‡ˆËfl ÔÓ ÒÂ‰Ì‡ ÎËÌËfl (10,16,17), Í‡-ÚÓ ÌflÍÓË ‡‚ÚÓË ‰Ó·‡‚flÚ Ë ÍÎËÌË˜ÌË ÍËÚÂËË (17).åàëåÄ ÒÂ ı‡‡ÍÚÂËÁË‡ Ò ‡Á‚ËÚËÂ Ì‡ ÁÌ‡˜ËÚÂÎÂÌÓÚÓÍ Ë ÔË ÔÓ‚ÂÊ‰‡ÌÂÚÓ Ì‡ ÍÓÌÒÂ‚‡ÚË‚ÌÓ ÎÂ˜ÂÌËÂ –ÎÓ¯‡ ÔÓ„ÌÓÁ‡ – 70-80% ÒÏ˙ÚÌÓÒÚ (1,2,3,4,6,7,9,15,16).å‡ÎË„ÌÂÌËflÚ ÏÓÁ˙˜ÂÌ ËÌÙ‡ÍÚ Â Ò ˜ÂÒÚÓÚ‡ ÓÍÓÎÓ 1-10%ÓÚ ÒÛÔ‡ÚÂÌÚÓË‡ÎÌËÚÂ ËÒıÂÏË˜ÌË ËÌÒÛÎÚË (1,7,9,10).àÏ‡ ‰‡ÌÌË, ˜Â ÒÂ ‡Á‚Ë‚‡ ÔÓ-˜ÂÒÚÓ ÔË ÔÓ-ÏÎ‡‰Ë ·ÓÎÌË,ÔË ÊÂÌË Ë ÔË ‚‡Ë‡ÌÚË Ì‡ ÇËÎËÁËÂ‚Ëfl Í˙„ (8). è‡ÚÓ-ÏÓÙÓÎÓ„Ë˜ÌËflÚ ÒÛ·ÒÚ‡Ú Â ÓÍÎÛÁËfl Ì‡ Í‡ÓÚË‰Ì‡Ú‡ËÎË ÒÂ‰Ì‡Ú‡ ÏÓÁ˙˜Ì‡ ‡ÚÂËfl (3,8). Ç Â‰ÍË ÒÎÛ˜‡Ë ÔÓ-‰Ó·ÌÓ ‡Á‚ËÚËÂ ÏÓÊÂ ‰‡ ËÏ‡ Ë ÔË ËÒıÂÏË˜ÂÌ ÏÓÁ˙˜ÂÌ ËÌ-ÒÛÎÚ ‚ ·‡ÒÂÈÌ‡ Ì‡ ÔÂ‰Ì‡ ÏÓÁ˙˜Ì‡ ‡ÚÂËfl (20). ï‡‡ÍÚÂ-

ÂÌ Á‡ åàëåÄ Â ËÁ‡ÁÂÌ ÏÓÁ˙˜ÂÌ ÓÚÓÍ Ò ‰ËÒÎÓÍ‡ˆËfl,ÍÓÈÚÓ ÒÂ ‡Á‚Ë‚‡ Ó·ËÍÌÓ‚ÂÌÓ ÓÚ ‚ÚÓË ‰Ó ÔÂÚË ‰ÂÌ ÒÎÂ‰ËÌÒÛÎÚ‡ Ë ‚Ó‰Ë ‰Ó ÔÓ‚Ë¯‡‚‡ÌÂ Ì‡ ËÌÚ‡Í‡ÌË‡ÎÌÓÚÓ Ì‡-Îfl„‡ÌÂ (ÙË„.1). óÂÒÚÓ ÒÂ ÒÚË„‡ ‰Ó Ú‡ÌÒÚÂÌÚÓË‡ÎÌÓıÂÌË‡ÌÂ Ë ÒÏ˙Ú (2,3,6,15,16). èÓ‚Ë¯‡‚‡ÌÂÚÓ Ì‡ ËÌÚ-‡Í‡ÌË‡ÎÌÓÚÓ Ì‡Îfl„‡ÌÂ ‚Ó‰Ë ‰Ó ÍÓÏÔÂÒËfl Ì‡ ÍÓÎ‡ÚÂ-‡ÎÌËÚÂ Ë ‰Û„ËÚÂ ÌÂÁ‡ÒÂ„Ì‡ÚË ÓÚ ËÌÒÛÎÚ‡ Ò˙‰Ó‚Â, Í‡-ÚÓ ÒÂ ÒÚË„‡ ‰Ó ‚ÚÓË˜ÌË ËÒıÂÏËË Ë ‡Á¯Ëfl‚‡ÌÂ Ì‡ Á‡-ÒÂ„Ì‡Ú‡Ú‡ ÓÚ ËÌÒÛÎÚ‡ ÁÓÌ‡ ÔË ÔÂÊË‚ÂÎËÚÂ Ô‡ˆËÂÌÚË.


é·ÁÓÑÖäéåèêÖëàÇçÄ äêÄçàéíéåàü èêà ãÖóÖçàÖ

çÄ åÄãàÉçÖç åéáöóÖç àçîÄêäí

Ö. Ç‡‚ÂÍ, ë. àÒ‡ÍÓ‚, Ñ. ÄÚ‡Ì‡ÒÓ‚‡, å. åËÎ‡ÌÓ‚‡ìåÅÄã ◊ñ‡Ëˆ‡ âÓ‡ÌÌ‡ – àëìã”, äÎËÌËÍ‡ ÔÓ ÌÂ‚ÓÎÓ„Ëfl

îË„.1 äí Ì‡ Ô‡ˆËÂÌÚ Ò Ï‡ÎË„ÌÂÌ ËÌÙ‡ÍÚ Ì‡ Ô˙‚Ë ‰ÂÌ ‚ Îfl‚Ó Ë Ì‡ ‚ÚÓË ‰ÂÌ ‚ ‰flÒÌÓ – ‰ÂÏ‡ÍË‡Ì‡ ÁÓÌ‡ Ì‡ ËÒıÂÏË˜ÂÌ ËÌÒÛÎÚ Ò ÓÚÓÍ Ë ‰ËÒÎÓÍ‡ˆËfl

á‡ ÍÎËÌË˜Ì‡Ú‡ Í‡ÚËÌ‡ Ò‡ ı‡‡ÍÚÂÌË ÚÂÊÍ‡ Ì‡˜‡ÎÌ‡ÒËÏÔÚÓÏ‡ÚËÍ‡ Ò ÚÂÊÍ‡ ıÂÏËÔ‡ÂÁ‡, ‰Ó ÔÎÂ„Ëfl, ÒÔÂ„Ì‡-ÚÓ ÓÚÍÎÓÌÂÌËÂ Ì‡ ÔÓ„ÎÂ‰‡ Ë „Î‡‚‡Ú‡ Ë ÔÓ„ÂÒË‡˘Ó ‰ÓÍÓÏ‡ Ì‡Û¯ÂÌËÂ Ì‡ Ò˙ÁÌ‡ÌËÂÚÓ (1,10,15). Ç ÎÂ˜ÂÌËÂÚÓ Ì‡ÚÂÁË Ô‡ˆËÂÌÚË ÒÂ ‰Ó·‡‚fl ÚÂ‡ÔËfl, ˆÂÎfl˘‡ ‰‡ Ì‡Ï‡ÎËÏÓÁ˙˜ÌËfl ÓÚÓÍ. åÂ‰ËÍ‡ÏÂÌÚÓÁÌÓÚÓ ÎÂ˜ÂÌËÂ ‚ÍÎ˛˜‚‡ ÓÒ-ÏÓÚË˜Ì‡ ÚÂ‡ÔËfl – „ÎËˆÂÓÎ Ë Ï‡ÌËÚÓÎ, ·‡·ËÚÛ‡ÚËËÎË ‰Û„‡ ÒÂ‰‡ˆËfl, ÍÓÚËÍÓÒÚÂÓË‰Ë, ÚÓÏÂÚ‡ÏËÌ; ÏÂ-‰ËÍ‡ÏÂÌÚÓÁÌÓ ÍÓÌÚÓÎË‡ÌÂ Ì‡ ‚˙ÁÏÓÊÌËÚÂ ıËÔÂ„ÎËÍÂ-ÏËfl Ë ıËÔÂÚÂÏËfl. çÂÏÂ‰ËÍ‡ÏÂÌÚÓÁÌËÚÂ ÏÂÍË‚ÍÎ˛˜‚‡Ú ÂÎÂ‚‡ˆËfl Ì‡ „Î‡‚‡Ú‡ Ì‡ 30 ÓC Ó„ÎÂ‰ Ì‡ ÔÓ-‰Ó·˙‚ÂÌÓÁÂÌ ‰ÂÌ‡Ê, ÛÏÂÂÌ‡ ıËÔÂ‚ÂÌÚËÎ‡ˆËfl, ıËÔÓÚÂÏËflË ÓÔÂ‡ÚË‚Ì‡ Ì‡ÏÂÒ‡. èÓ„ÌÓÁ‡Ú‡ ÔË ÚÂÁË Ô‡ˆËÂÌÚË ÂÎÓ¯‡ Ò ÍÎ‡ÒË˜ÂÒÍ‡Ú‡ ÚÂ‡ÔËfl, ‚ÍÎ˛˜‚‡˘‡ ‚ÒË˜ÍË ËÁ·Ó-ÂÌË ÒÂ‰ÒÚ‚‡ Á‡ ÎÂ˜ÂÌËÂ, Ò ËÁÍÎ˛˜ÂÌËÂ Ì‡ ıËÛ„Ë˜Ì‡Ú‡Ì‡ÏÂÒ‡ Ë ıËÔÓÚÂÏËflÚ‡. ÑÓ 80% ÓÚ ·ÓÎÌËÚÂ Á‡„Ë‚‡Ú, ‡„ÓÎflÏ‡ ˜‡ÒÚ ÓÚ ÓˆÂÎÂÎËÚÂ Ò‡ ÒËÎÌÓ ËÌ‚‡ÎË‰ËÁË‡ÌË – 5ÚÓ˜ÍË ÔÓ ÏÓ‰ËÙËˆË‡Ì‡Ú‡ ê‡ÌÍËÌ ÒÍ‡Î‡ (mRS -ÙË„.2).

èË ÔÓ‚ÂÊ‰‡ÌÂÚÓ Ì‡ ‰ÂÍÓÏÔÂÒË‚Ì‡ ıËÛ„Ëfl ÒÏ˙ÚÌÓ-ÒÚÚ‡ Ì‡Ï‡Îfl‚‡ ‰Ó ÓÍÓÎÓ 30% ÔË ÓÚÌÓÒËÚÂÎÌÓ ÔÓ-Í˙ÒÌ‡Ì‡ÏÂÒ‡ Ë ‰Ó ÓÍÓÎÓ 20% ÔË ‡ÌÌ‡ ÓÔÂ‡ˆËfl, Í‡ÚÓ ÔË ‡Ì-ÌËÚÂ ÓÔÂ‡ˆËË ÒÂ‰ÌËÚÂ ÒÚÓÈÌÓÒÚË ÔÓ mRS Ò‡ ÏÂÊ‰Û 2Ë 2.5 (1,2,3,4,6,7,13,15,18,19,20). ÖÙÂÍÚË‚ÌÓÒÚÚ‡ Ì‡ ‰Â-ÍÓÏÔÂÒË‚Ì‡Ú‡ ıËÛ„Ëfl ·Â¯Â ‰ÓÍ‡Á‡Ì‡ Ò ‡Ì‰ÓÏËÁË‡ÌËÍÎËÌË˜ÌË ÔÓÛ˜‚‡ÌËfl (1,2,3). ïËÔÓÚÂÏËflÚ‡ Â ‚ÒÂ Ó˘ÂÌÓ‚ ÏÂÚÓ‰ ‚ ÔÓˆÂÒ Ì‡ ÔÓÛ˜‚‡ÌÂ, Ò ‰Ó·Ë Ì‡˜‡ÎÌË ÂÁÛÎ-Ú‡ÚË. àÁÔÓÎÁ‚‡ ÒÂ ÔÂ‰ËÏÌÓ ÛÏÂÂÌÓ ÔÓÌËÊ‡‚‡ÌÂ Ì‡ÚÂÏÔÂ‡ÚÛ‡Ú‡ ‰Ó 33 „‡‰ÛÒ‡ (7,18,19).

ÑÂÍÓÏÔÂÒË‚Ì‡Ú‡ ıËÛ„Ëfl Â ÏÂÚÓ‰, ÔË ÍÓÈÚÓ ÒÂÓÚÒÚ‡Ìfl‚‡ ÍÓÒÚÌÓ Î‡Ï·Ó, Í‡ÚÓ ÔÓ ÚÓÁË Ì‡˜ËÌ ÒÂ ÔÂÓ-‰ÓÎfl‚‡ Ó„‡ÌË˜ÂÌËfl Ó·ÂÏ Ì‡ ˜ÂÂÔ‡ Ë ÌÂ ÒÂ ÒÚË„‡ ‰Ó ÔÓ‚Ë-¯‡‚‡ÌÂ Ì‡ ËÌÚ‡Í‡ÌË‡ÎÌÓÚÓ Ì‡Îfl„‡ÌÂ Ë ÌÂ„Ó‚ËÚÂ ÒÎÂ‰-ÒÚ‚Ëfl. ÑÂÍÓÏÔÂÒËflÚ‡ ÒÂ ËÁÔÓÎÁ‚‡ ÌÂfl‰ÍÓ ÔË ‰Û„Ë Á‡-·ÓÎfl‚‡ÌËfl ‚ Ó·Î‡ÒÚÚ‡ Ì‡ ÌÂ‚ÓıËÛ„ËflÚ‡. íÂÏËÌ˙Ú‚˙ÚÂ¯Ì‡ ÏÓÁ˙˜Ì‡ ‰ÂÍÓÏÔÂÒË‚Ì‡ ıËÛ„Ëfl ÒÂ ÓÚÌ‡Òfl Á‡fl‰ÍÓ ÒÂ˘‡ÌÓÚÓ ÓÚÒÚ‡Ìfl‚‡ÌÂ Ì‡ ÏÓÁ˙˜ÌË ÒÚÛÍÚÛË(6). ìÔÓÚÂ·‡Ú‡ Ì‡ ‰ÂÍÓÏÔÂÒË‚Ì‡ ıËÛ„Ëfl ÔË åàë-åÄ ‰‡ÚË‡ ÓÚ 1935, ÍÓ„‡ÚÓ Ò‡ ÔÓ‚ÂÊ‰‡ÌË Ô˙‚ËÚÂ ÔÓ-Û˜‚‡ÌËfl (15). Ç Í‡fl Ì‡ 90-ÚÂ „Ó‰ËÌË Schwab Ë Ò˙Ú. ÔÛ·-ÎËÍÛ‚‡Ú ÒÂËfl ÓÚ 63 ÎÂÍÛ‚‡ÌË ÓÔÂ‡ÚË‚ÌÓ Ô‡ˆËÂÌÚË, ÓÚÍÓËÚÓ Ò‡ÏÓ 17 Ò‡ ÔÓ˜ËÌ‡ÎË (15,26). çÂÁ‡‚ËÒËÏÓ ÓÚ ÚÓ‚‡‰Ó Ì‡˜‡ÎÓÚÓ Ì‡ Ì‡ÒÚÓfl˘ÓÚÓ ıËÎfl‰ÓÎÂÚËÂ ÎËÔÒ‚‡ı‡ ÌÂÓÒ-ÔÓËÏË ‰ÓÍ‡Á‡ÚÂÎÒÚ‚‡ Á‡ ÂÙÂÍÚË‚ÌÓÒÚÚ‡ Ì‡ ÏÂÚÓ‰‡ÔË Ô‡ˆËÂÌÚË Ò Ï‡ÎË„ÌÂÌ ËÌÙ‡ÍÚ (5). èÛ·ÎËÍÛ‚‡ÌË ·flı‡ÍÎËÌË˜ÌË ÒÎÛ˜‡Ë Ë ÓÚÌÓÒËÚÂÎÌÓ Ï‡ÎÍË ÒÂËË Ô‡ˆËÂÌÚË,ÌflÍÓË ÓÚ ÍÓËÚÓ ·flı‡ ÍÓÌÚÓÎË‡ÌË. ê‡Á‚ËÚËÂÚÓ Ì‡ ÏÂ-ÚÓ‰‡ ‰ÓÍ‡Á‡ Í‡ÚÓ ÔÓ-ÂÙÂÍÚË‚Ì‡ ‡ÌÌ‡Ú‡ ‰ÂÍÓÏÔÂÒË‚Ì‡ıËÛ„Ëfl – ÔÂ‰Ë ÁÌ‡˜ËÏÓ ÔÓ‚Ë¯‡‚‡ÌÂ Ì‡ ËÌÚ‡Í‡ÌË‡Î-ÌÓÚÓ Ì‡Îfl„‡ÌÂ (1,15). çÂÁ‡‚ËÒËÏÓ ÓÚ ÚÓ‚‡ ËÏ‡ ‰‡ÌÌË Á‡ÂÙÂÍÚË‚ÌÓÒÚ, Ï‡Í‡ Ë ÔÓ-Ï‡ÎÍ‡, Ë Ì‡ Í˙ÒÌ‡Ú‡ ‰ÂÍÓÏÔÂ-ÒËfl (1,13,15,20).

ë Ó„ÎÂ‰ Ì‡ ‰ÓÍ‡Á‚‡ÌÂ Ë ÛÚÓ˜Ìfl‚‡ÌÂ Ì‡ ÔÓÎÁÓÚ‚ÓÌÓÒÚ-Ú‡ Ì‡ ‰ÂÍÓÏÔÂÒË‚Ì‡Ú‡ ıËÛ„Ëfl ÔË åàëåÄ ·flı‡ ÓÒ˙-˘ÂÒÚ‚ÂÌË ÌflÍÓÎÍÓ ÍÎËÌË˜ÌË ÔÓÛ˜‚‡ÌËfl – HeaDDFIRST,HeMMI, Ë Â‚ÓÔÂÈÒÍËÚÂ HAMLET, DECIMAL Ë DES-

TINY. êÂÁÛÎÚ‡ÚËÚÂ ÓÚ Â‚ÓÔÂÈÒÍËÚÂ ÔÓÛ˜‡‚‡ÌËfl ·flı‡Ó·Â‰ËÌÂÌË, Á‡ ‰‡ ÒÂ ÔÓÒÚË„ÌÂ ÔÓ-‡ÌÓ ÒÚ‡ÚËÒÚË˜ÂÒÍ‡ÁÌ‡˜ËÏÓÒÚ, ÔÓ‡‰Ë ËÁ‡ÁÂÌÓ ÔÂ‰ËÏÒÚ‚Ó Ì‡ ÂÁÛÎÚ‡ÚË-ÚÂ ÓÚ ÎÂ˜ÂÌËÂÚÓ Ì‡ Ô‡ˆËÂÌÚËÚÂ ‡Ì‰ÓÏËÁË‡ÌË Á‡ ıË-Û„Ë˜Ì‡ ËÌÚÂ‚ÂÌˆËfl. Ä·ÒÓÎ˛ÚÌÓÚÓ Ì‡Ï‡ÎÂÌËÂ Ì‡ ËÒ-Í‡ Â 51% ÔË ‰ËıÓÚÓÏËÁË‡ÌÂ Ì‡ mRS <_ 4 Ë >_ 5, 23% ÔË‰ËıÓÚÓÏËÁË‡ÌÂ ÔÓ mRS <_ 3 Ë >_ 4 Ë 50% Á‡ ÒÏ˙ÚÌÓÒÚ-Ú‡. á‡ ÔÓÛ˜‚‡ÌÂÚÓ DESTINY, ÔÂÊË‚flÎËÚÂ Ò‡ 82% ‚„ÛÔ‡Ú‡ Ì‡ ÓÔÂ‡ÚË‚ÌÓ ÎÂÍÛ‚‡ÌËÚÂ ÒÔflÏÓ 47% ‚ „ÛÔ‡-Ú‡ Ò ÍÓÌÒÂ‚‡ÚË‚ÌÓ ÎÂ˜ÂÌËÂ, ÓˆÂÌÂÌËÚÂ ÔÓ mRS 0 ‰Ó 3 Ò‡47% ÓÚ ÓÔÂË‡ÌËÚÂ ·ÓÎÌË ÒÔflÏÓ 27% ‚ ÍÓÌÚÓÎÌ‡Ú‡„ÛÔ‡ Ë ÓˆÂÌÂÌËÚÂ ÔÓ mRS 0-4 Ò‡ 77% ÓÚ Í‡ÌËÓÚÓÏË‡-ÌËÚÂ Ô‡ˆËÂÌÚË ÒÂ˘Û 33% ÔË ÏÂ‰ËÍ‡ÏÂÌÚÓÁÌÓ ÎÂÍÛ‚‡-ÌËÚÂ ·ÓÎÌË (1). èÓ‰„ÓÚÓ‚Í‡Ú‡ Ì‡ ‰ËÁ‡ÈÌ‡ Ì‡ ÔÓÛ˜‚‡ÌÂ-ÚÓ DESTINY ·Â¯Â ÔÂ‰¯ÂÒÚ‚‡Ì‡ ÓÚ 2 „ÓÎÂÏË ÍÓÌÚÓÎË-‡ÌË ÒÂËË (15). íÓ‚‡ ÓÔÂ‰ÂÎfl Ë Ò‡ÏÓÚÓ ÔÓÛ˜‚‡ÌÂ Í‡ÚÓÂ‰ÌÓ ÓÚ Ì‡È-‰Ó·Â ÔÎ‡ÌË‡ÌËÚÂ Ë ÓÒ˙˘ÂÒÚ‚ÂÌË ÍÎËÌË˜ÌËÔÓÛ˜‚‡ÌËfl, ‚˙ÔÂÍË ˜Â ÔÓ-„ÓÎÂÏËfl ÔÓˆÂÌÚ ÔÂÊË‚ÂÎËÔ‡ˆËÂÌÚË ‚ „ÛÔ‡Ú‡ Ò ÍÓÌÒÂ‚‡ÚË‚ÌÓ ÎÂ˜ÂÌËÂ ÒÔflÏÓ ˆË-ÚË‡ÌËÚÂ ÔÓ-‡ÌÌË ÂÁÛÎÚ‡ÚË – ÒÏ˙ÚÌÓÒÚ 53% ‚ „Û-Ô‡Ú‡ Ì‡ ÍÓÌÒÂ‚‡ÚË‚ÌÓ ÎÂÍÛ‚‡ÌËÚÂ ÒÔflÏÓ 80%ÒÏ˙ÚÌÓÒÚ, Ò˙Ó·˘‡‚‡Ì‡ ÓÚ ÔÓ˜ÚË ‚ÒË˜ÍË ‡‚ÚÓË Í‡ÚÓÒÏ˙ÚÌÓÒÚ Ì‡ ÎÂÍÛ‚‡ÌË ÍÓÌÒÂ‚‡ÚË‚ÌÓ ·ÓÎÌË Ò Ï‡ÎË„ÌÂÌËÌÙ‡ÍÚ - ÔÓÒÚ‡‚fl ‚˙ÔÓÒ‡ Á‡ ÒÔÂˆËÙË˜ÌÓÒÚÚ‡ Ì‡‚ÍÎ˛˜‚‡˘ËÚÂ ÍËÚÂËË. àÁ‚ÂÒÚÌÓ Â Ó·‡˜Â, ˜Â ÒÚËÍÚ-ÌËflÚ ÍÓÌÚÓÎ Ì‡ Ô‡ˆËÂÌÚËÚÂ ‚ ‡ÏÍËÚÂ Ì‡ ÍÎËÌË˜ÌÓÔÓÛ˜‚‡ÌÂ ÏÓÊÂ ‰‡ ‰Ó‚Â‰Â ÔÓÌflÍÓ„‡ ‰Ó ÔÓ-‰Ó·Ë ÂÁÛÎÚ‡-ÚË ÓÚ ÚÂÁË ‚ ÍÎËÌË˜Ì‡Ú‡ Ô‡ÍÚËÍ‡.

éÒÌÓ‚ÌËflÚ ‚˙ÔÓÒ Í‡Ò‡Â˘ ‰ÂÍÓÏÔÂÒË‚Ì‡Ú‡ ıËÛ-„Ëfl ÒÂ ÓÚÌ‡Òfl ‰Ó ÔÓ‰·Ó‡ Ì‡ ÔÓ‰ıÓ‰fl˘ËÚÂ Á‡ ÓÔÂ‡ˆËflÔ‡ˆËÂÌÚË. íÓÁË ‚˙ÔÓÒ ËÏ‡ 2 ‡ÒÔÂÍÚ‡ – ÍÓË Ò‡ Ô‡ˆËÂÌÚË-ÚÂ, ÍÓËÚÓ ·Ëı‡ ‡Á‚ËÎË Ï‡ÎË„ÌÂÌ ËÌÙ‡ÍÚ Ë ÍÓË Ô‡ˆËÂÌ-ÚË ËÏ‡Ú ÔÓ‚Ë¯ÂÌ ËÒÍ Á‡ ÓÔÂ‡ÚË‚Ì‡ ËÌÚÂ‚ÂÌˆËfl.èÓÛ˜‚‡ÌÂÚÓ DESTINY ‰‡‚‡ ÍËÚÂËË, ÍÓËÚÓ ÏÓ„‡Ú ‰‡ÒÂ ËÁÔÓÎÁ‚‡Ú ‚ ÂÊÂ‰ÌÂ‚Ì‡Ú‡ Ô‡ÍÚËÍ‡ (ÙË„.3). Ç˙Á‡ÒÚ

18 ‰Ó 60 „Ó‰ËÌË, NIHSS Ì‡‰ 18 Á‡ ÌÂ‰ÓÏËÌ‡ÌÚÌ‡Ú‡ Ë Ì‡‰20 Á‡ ‰ÓÏËÌ‡ÌÚÌ‡Ú‡ ıÂÏËÒÙÂ‡, ÍÓÎË˜ÂÒÚ‚ÂÌÓ Ì‡Ï‡ÎÂÌËÂÌ‡ Ò˙ÁÌ‡ÌËÂÚÓ, äí ‚ÍÎ˛˜‚‡˘ ÔÓÌÂ 2/3 ÓÚ ÚÂËÚÓËflÚ‡


îË„.2 ÏÓ‰ËÙËˆË‡Ì‡ ê‡ÌÍËÌ ÒÍ‡Î‡ – Ò˙Í‡ÚÂÌ ‚‡Ë‡ÌÚ

0. çflÏ‡ ÒËÏÔÚÓÏË1. àÏ‡ ÒËÏÔÚÓÏË, ÌÓ ÏÓÊÂ ‰‡ ËÁ‚˙¯‚‡ ‚ÒË˜ÍË Ó·Ë˜‡ÈÌË ‰ÂÈÌÓÒÚË

Í‡ÍÚÓ ÔÂ‰Ë ËÌÒÛÎÚ‡2. ÉËÊË ÒÂ Ò‡Ï Á‡ ÒÂ·Â ÒË3. àÁËÒÍ‚‡ ÔÓÏÓ˘, ÌÓ ıÓ‰Ë ·ÂÁ ÔÓ‰ÍÂÔ‡4. çÂ ÏÓÊÂ ‰‡ ıÓ‰Ë ·ÂÁ ÔÓÏÓ˘, ÌÂ ÒÂ „ËÊË Á‡ ÌÛÊ‰ËÚÂ ÒË, ÌÓ ÏÓÊÂ ‰‡

ÒÂ ÓÒÚ‡‚fl Ò‡Ï Á‡ ËÁ‚ÂÒÚÌË ÔÂËÓ‰Ë ÔÂÁ ‰ÂÌfl5. àÁËÒÍ‚‡ ÔÓÒÚÓflÌÌÓ Ì‡·Î˛‰ÂÌËÂ

îË„.3 äËÚÂËË Ì‡ ÔÓÛ˜‚‡ÌÂÚÓ DESTINY

ÇäãûóÇÄôà äêàíÖêàà● Ç˙Á‡ÒÚ 18-60 „Ó‰ËÌË● äÎËÌË˜ÌË ‰‡ÌÌË Á‡ ËÌÙ‡ÍÚ Ì‡ ·‡ÒÂÈÌ‡ Ì‡ ÒÂ‰Ì‡ ÏÓÁ˙˜Ì‡ ‡ÚÂËfl(ëåÄ) Ò ÓˆÂÌÍ‡ ÔÓ NIHSS>18 Á‡ ÎÂÁËË Ì‡ ÌÂ‰ÓÏËÌ‡ÌÚÌ‡Ú‡ ıÂÏËÒÙÂ‡ ËÌ‡‰ 20 Á‡ ÎÂÁËË Ì‡ ‰ÓÏËÌ‡ÌÚÌ‡Ú‡ ıÂÏËÒÙÂ‡● ç‡Ï‡ÎÂÌËÂ Ì‡ Ò˙ÁÌ‡ÌËÂÚÓ ‰Ó ÔÓÌÂ 1 ÚÓ˜Í‡ ÓÚ 1‡ Ì‡ NIHSS● äí – ÛÌËÎ‡ÚÂ‡ÎÂÌ ËÌÒÛÎÚ ‚ ëåÄ, Ó·ı‚‡˘‡˘ ÔÓÌÂ 2/3 ÓÚÚÂËÚÓËflÚ‡ Ë Ó·ı‚‡˘‡˘ ÔÓÌÂ ˜‡ÒÚ ÓÚ ·‡Á‡ÎÌËÚÂ fl‰‡ Ò˙Ò ËÎË ·ÂÁ‰ÓÔ˙ÎÌËÚÂÎÌÓ Á‡Òfl„‡ÌÂ Ì‡ ÔÂ‰Ì‡ ËÎË Á‡‰Ì‡ ÏÓÁ˙˜Ì‡ ‡ÚÂËfl● ç‡˜‡ÎÓ Ì‡ ÒËÏÔÚÓÏËÚÂ >12 Ë <36 ˜‡Ò‡ ÔÂ‰Ë ‚˙ÁÏÓÊÌ‡ ıËÛ„Ë˜Ì‡ËÌÚÂ‚ÂÌˆËfl● Ç˙ÁÏÓÊÌÓÒÚ Á‡ Á‡ÔÓ˜‚‡ÌÂ Ì‡ ÎÂ˜ÂÌËÂÚÓ/ÓÔÂ‡ˆËflÚ‡ ‚ ‡ÏÍËÚÂ Ì‡ 6˜‡Ò‡ ÒÎÂ‰ ‡Ì‰ÓÏËÁ‡ˆËflÚ‡● èËÒÏÂÌÓ ËÌÙÓÏË‡ÌÓ Ò˙„Î‡ÒËÂàáäãûóÇÄôà äêàíÖêàà● èÂÏÓ·Ë‰Ì‡ mRS >_ 2● èÂÏÓ·Ë‰ÂÌ Barthel Index <95● éˆÂÌÍ‡ ÔÓ Glasgow Coma Scale <6● Ñ‚ÛÒÚ‡ÌÌÓ ÙËÍÒË‡ÌË Ë ‰ËÎ‡ÚË‡ÌË ÁÂÌËˆË● ë˙Ô˙ÚÒÚ‚‡˘‡ ÏÓÁ˙˜Ì‡ ÎÂÁËfl, ÍÓflÚÓ ÏÓÊÂ ‰‡ ÔÓ‚ÎËflÂ ËÁıÓ‰‡ ÓÚÁ‡·ÓÎfl‚‡ÌÂÚÓ● èÓÒÚ‡ÌÒÚ‚ÓÁ‡ÂÏ‡˘‡ ıÂÏÓ‡„Ë˜Ì‡ Ú‡ÌÒÙÓÏ‡ˆËfl Ì‡ ËÌÒÛÎÚ‡● é˜‡Í‚‡Ì‡ ÔÓ‰˙ÎÊËÚÂÎÌÓÒÚ Ì‡ ÊË‚ÓÚ‡ ÔÓ‰ 3 „Ó‰ËÌË● ÑÛ„Ó ÒÂËÓÁÌÓ Á‡·ÓÎfl‚‡ÌÂ, ÍÓÂÚÓ ÏÓÊÂ ‰‡ ÔÓ‚ÎËflÂ ËÁıÓ‰‡● àÁ‚ÂÒÚÌ‡ ÍÓ‡„ÛÎÓÔ‡ÚËfl ËÎË ÒËÒÚÂÏÌÓ Í˙‚ÂÌÂ● äÓÌÚ‡ËÌ‰ËÍ‡ˆËË Á‡ ‡ÌÂÒÚÂÁËfl

Ì‡ ëåÄ Ë ÔÓÌÂ ˜‡ÒÚË˜ÌÓ ·‡Á‡ÎÌËÚÂ fl‰‡, Ì‡˜‡ÎÓ Ì‡ ÒËÏÔ-ÚÓÏËÚÂ ÓÚ 12 ‰Ó 36 ˜‡Ò‡ ÔÂ‰Ë ıËÛ„Ë˜Ì‡Ú‡ ËÌÚÂ‚ÂÌ-ˆËfl, ÓˆÂÌÍ‡ ÔÓ ÉÎ‡Á„ÓÛ Ì‡‰ 5, ÓÚÒ˙ÒÚ‚ËÂ Ì‡ ‰‚ÛÒÚ‡ÌÌÓÙËÍÒË‡ÌË Ë ‰Ë‡Î‡ÚË‡ÌË ÁÂÌËˆË, ÎËÔÒ‡ ÔÓÒÚ‡ÌÒÚ‚Ó

Á‡ÂÏ‡˘‡ ıÂÏÓ‡„Ë˜Ì‡ Ú‡ÌÒÙÓÏ‡ˆËfl, ÎËÔÒ‡ Ì‡ ËÁ‚ÂÒÚÌÓÌ‡Û¯ÂÌËÂ ‚ Í˙‚ÓÒ˙ÒË‚‡ÌÂÚÓ, Í‡ÍÚÓ Ë ÌÂÌ‡ÎË˜ËÂÍÓÌÚ‡ËÌ‰ËÍ‡ˆËË Á‡ ‡ÌÂÒÚÂÁËfl (1).

í˙È Í‡ÚÓ Ò‡Ï‡Ú‡ Ì‡È-˜ÂÒÚÓ ËÁÔÓÎÁ‚‡Ì‡ ‰ÂÙËÌËˆËfl Ì‡Ï‡ÎË„ÌÂÌËfl ËÌÙ‡ÍÚ Â Ò‚˙Á‡Ì‡ Ò ËÁfl‚‡Ú‡ Ì‡ ÏÓÁ˙˜ÌËflÓÚÓÍ, ‡ ÓÚ ‰Û„‡ ÒÚ‡Ì‡ ‰ÂÍÓÏÔÂÒËflÚ‡ Â ÔÓ-ÂÙÂÍÚË‚Ì‡‡ÍÓ ÒÂ ËÁ‚˙¯Ë ‡ÌÓ, ÔÂ‰Ë ÔÓ‚Ë¯‡‚‡ÌÂÚÓ Ì‡ ËÌÚ‡Í‡-ÌË‡ÎÌÓÚÓ Ì‡Îfl„‡ÌÂ, ÓÚ ËÁÍÎ˛˜ËÚÂÎÌ‡ ‚‡ÊÌÓÒÚ Â ÓÚÍË-‚‡ÌÂÚÓ Ì‡ ·ÂÎÂÁË, ÔÓÍ‡Á‚‡˘Ë ˜Â ·ÓÎÌËflÚ ·Ë ‡Á‚ËÎ åàë-åÄ ÔÂ‰Ë ‡Á‚ËÚËÂÚÓ Ì‡ ÓÚÓÍ‡. ä˙Ï Ì‡ÒÚÓfl˘Ëfl ÏÓ-ÏÂÌÚ Ò‡ ÔÓÛ˜ÂÌË ÌflÍÓÎÍÓ „ÛÔË ÔÓ„ÌÓÒÚË˜ÌË ·ÂÎÂÁË –‡Ì‡ÏÌÂÒÚË˜ÌË, ÍÎËÌË˜ÌË, ·ËÓıËÏË˜ÌË Ë Ó·‡ÁÌË.

ä˙Ï ‡Ì‡ÏÌÂÒÚË˜ÌËÚÂ ÔÓ„ÌÓÒÚË˜ÌË ·ÂÎÂÁË ÒÂ ÓÚÌ‡ÒflÌ‡ Ô˙‚Ó ÏflÒÚÓ ‚˙Á‡ÒÚÚ‡ – ÔÓ-Á‡ÒÚ‡¯ÂÌË Ò‡ ÏÎ‡‰ËÚÂÔ‡ˆËÂÌÚË (8). Ç˙Á‡ÒÚ ‰Ó 60 „Ó‰ËÌË Â Ë ‚ÍÎ˛˜‚‡˘ ÍËÚÂ-ËË Á‡ ÔÓÛ˜‚‡ÌÂÚÓ DESTINY (1). ÇÂÓflÚÌÓ ÚÓÁË ÍËÚÂ-ËÈ ˘Â ÔÂÚ˙ÔË ˜‡ÒÚË˜Ì‡ ÔÂÓˆÂÌÍ‡, Ú˙È Í‡ÚÓ åàëåÄ ÒÂ ÒÂ˘‡ Ë ÔË Ô‡ˆËÂÌÚË Ì‡‰ 90 „Ó‰ËÌË (10). èÓ-‚Ë¯ÂÌ ËÒÍ Á‡ Ï‡ÎË„ÌÂÌ ıÓ‰ Ì‡ àåà Ì‡ ëåÄ ËÏ‡ ÔË ÊÂ-ÌË, ÔË ÎËÔÒ‡ Ì‡ ‡Ì‡ÏÌÂÁ‡ Á‡ ÔÂ‰Ë¯ÂÌ ËÌÒÛÎÚ, Í‡‰ËÓÏÂ-„‡ÎËfl, ‡ÌÓÏ‡ÎËË Ì‡ ÇËÎËÁËÂ‚Ëfl Í˙„, ıËÔÂÚÓÌËfl, Ò˙‰Â˜-Ì‡ ÌÂ‰ÓÒÚ‡Ú˙˜ÌÓÒÚ (8,16).

ä˙Ï ÍÎËÌË˜ÌËÚÂ ·ÂÎÂÁË ÏÓÊÂ ‰‡ ÒÂ ÓÚÌÂÒÂ ÔÂ‰Ë ‚ÒË˜-ÍÓ ÚÂÊÍ‡Ú‡ Ì‡˜‡ÎÌ‡ ÒËÏÔÚÓÏ‡ÚËÍ‡ (10,16). Ç DESTINY„‡ÌËˆ‡Ú‡ Â ÔÓÒÚ‡‚ÂÌ‡ Ì‡ 18/20 ÚÓ˜ÍË, Í‡ÚÓ ÔÓÌÂ 1 ÓÚÚflı Â ÓÚ 1‡ (ÙË„.4), Í‡ÚÓ ‰Û„Ë ‡‚ÚÓË ÔÂ‰Î‡„‡Ú „‡ÌË-ˆË 22 ËÎË 20/15(1,10,24). èÓ-‚ËÒÓÍ ËÒÍ ËÏ‡ ÔË ÓÍÎÛÁËflÌ‡ Í‡ÓÚË‰Ì‡ ‡ÚÂËfl (8). É‡‰ÂÌÂ Ë ÔÓ‚˙˘‡ÌÂ ÔÂÁ Ô˙-‚ËÚÂ 24 ˜‡Ò‡ Ë ÒËÒÚÓÎË˜ÌÓ Äç >_ 180 Ì‡ 12-ÚË ˜‡Ò ÔÓÍ‡Á-‚‡Ú ÔÓ-‚ËÒÓÍ ËÒÍ Á‡ ‡Á‚ËÚËÂ Ì‡ Ï‡ÎË„ÌÂÌ ËÌÙ‡ÍÚ (24).ê‡Á‚ËÚËÂÚÓ Ì‡ ÒËÏÔÚÓÏ‡ÚËÍ‡Ú‡ ÔÓÁ‚ÓÎfl‚‡ ÔÓ-ÒË„ÛÌ‡‰Ë‡„ÌÓÁ‡ Ì‡ åàëåÄ, ÌÓ ÂÁÛÎÚ‡ÚËÚÂ ÔË Í˙ÒÌ‡ ËÌÚÂ-‚ÂÌˆËfl Ò‡ ÔÓ-ÎÓ¯Ë (15).

ÅËÓıËÏË˜ÌËÚÂ Ï‡ÍÂË Ò‡ ÓÒÓ·ÂÌÓ ÔÂÒÔÂÍÚË‚ÌË.Serena Ë Ò˙ÚÛ‰ÌËˆË ËÁÒÎÂ‰‚‡Ú ‚ Ô˙‚ËÚÂ 24 ˜‡Ò‡ 8 ÒÛ·Ò-Ú‡ÌˆËË, ÍÓËÚÓ ÒÂ ÔËÂÏ‡Ú Ò‚˙Á‡ÌË Ò ‡ÁÛ¯‡‚‡ÌÂÚÓ Ì‡Í˙‚ÌÓ-ÏÓÁ˙˜Ì‡Ú‡ ·‡ËÂ‡ Ë ÛÒÚ‡ÌÓ‚fl‚‡Ú 90% ˜ÛÒÚ‚Ë-ÚÂÎÌÓÒÚ Ë 100% ÒÔÂˆËÙË˜ÌÓÒÚ Á‡ ÍÎÂÚ˙˜ÌËfl ÙË·ÓÌÂÍ-ÚËÌ (9). èÓ„ÌÓÒÚË˜Ì‡ ÁÌ‡˜ËÏÓÒÚ ÒÂ ÛÒÚ‡ÌÓ‚fl‚‡ ‚ Ô˙-‚ËÚÂ 24 ˜‡Ò‡ Ë Á‡ ÒÂÛÏÌËfl ‡ÒÚÓ„ÎË‡ÎÂÌ ÔÓÚÂËÌ S100B(12). ìÒÚ‡ÌÓ‚ÂÌ‡ ÍÓÂÎ‡ˆËfl ËÏ‡ ÏÂÊ‰Û ËÒÍ‡ Á‡ Ï‡ÎË„ÌÂÌËÌÙ‡ÍÚ Ë Ô˙‚ÓÌ‡˜‡ÎÌÓ ÔÓ‚Ë¯ÂÌËfl ·ÓÈ ÎÂ‚ÍÓˆËÚË.

é·‡ÁÌËÚÂ ËÁÒÎÂ‰‚‡ÌËfl ‰‡‚‡Ú ‡ÁÎË˜Ì‡ ËÌÙÓÏ‡ÚË‚-ÌÓÒÚ ‚ ‡ÌÌ‡Ú‡ Ù‡Á‡ Ì‡ ËÌÒÛÎÚ‡. ÑÓ·Ë ‰‡ÌÌË ÒÂ ÔÓÎÛ˜‡-‚‡Ú ÓÚ êÖí, ÏÛÎÚËÙ‡ÁÓ‚‡ ÒÔË‡ÎÌ‡ äí, SPECT – 82%˜Û‚ÒÚ‚ËÚÂÎÌÓÒÚ, 98% ÒÔÂˆËÙË˜ÌÓÒÚ; ‰ËÙÛÁËÓÌÂÌ Ë ÔÂ-ÙÛÁËÓÌÂÌ MRI (11,14,16,17). í‡ÌÒÍ‡ÌË‡ÎÌ‡Ú‡ ˆ‚ÂÚÌÓÍÓ‰Ë‡Ì‡ ‰ÛÔÎÂÍÒÒÓÌÓ„‡ÙËfl ÔÓÁ‚ÓÎfl‚‡ ÓˆÂÌÍ‡ Ì‡ ËÁÏÂ-ÒÚ‚‡ÌÂÚÓ ÔÓ ÒÂ‰ËÌÌ‡ ÎËÌËfl Ì‡ 16-ÚËfl ˜‡Ò (21). çÂÁ‡‚Ë-ÒËÏÓ ÓÚ ÏÌÓ„ÓÓ·‡ÁËÂÚÓ Ë Í‡˜ÂÒÚ‚‡Ú‡ Ì‡ ÓÒÚ‡Ì‡ÎËÚÂÓ·‡ÁÌË ËÁÒÎÂ‰‚‡ÌËfl ÔÓÌ‡ÒÚÓfl˘ÂÏ ‚ Ô‡ÍÚËÍ‡Ú‡, Í‡ÍÚÓË ‚ ‡Ì‰ÓÏËÁË‡ÌËÚÂ ÔÓÛ˜‚‡ÌËfl Ì‡È-˜ÂÒÚÓ ÒÂ ËÁÔÓÎÁ‚‡ÍÓÏÔ˛Ú˙Ì‡Ú‡ ÚÓÏÓ„‡ÙËfl (1,10,16,22,23,24). ÑÂÏ‡Í‡-ˆËflÚ‡ Ì‡ „ÓÎflÏ‡ ËÒıÂÏË˜Ì‡ ÁÓÌ‡ ‚ ·‡ÒÂÈÌ‡ Ì‡ ÒÂ‰Ì‡ÏÓÁ˙˜Ì‡ ‡ÚÂËfl Â ÒÂ‰ Ì‡È-ÒË„ÛÌËÚÂ Ï‡ÍÂË Á‡ ËÒÍÓÚ åàëåÄ. çflÍÓË ‡‚ÚÓË ÔÓÒÚ‡‚flÚ „‡ÌËˆ‡Ú‡ Ì‡ ‰Â-Ï‡Í‡ˆËfl Ì‡ 50%, ‰Û„Ë Ì‡ 1/3 ËÎË 2/3 ÓÚ ·‡ÒÂÈÌ‡ Ì‡ ÒÂ‰-Ì‡ ÏÓÁ˙˜Ì‡ ‡ÚÂËfl ‚ Á‡ÒÂ„Ì‡Ú‡Ú‡ ÓÚ ËÌÒÛÎÚ‡ ÒÚ‡Ì‡, ‡Mori Ë Ò˙ÚÛ‰ÌËˆË ÛÒÚ‡ÌÓ‚fl‚‡Ú ˜ÂÁ ‰ËÒÍËÏËÌ‡ÚË‚ÂÌ‡Ì‡ÎËÁ „‡ÌËˆ‡ ÓÚ 240 ÒÏ3 (1,6,10,24). äÓÏÔÂÒËflÚ‡ Ì‡sella media ÔÓÍ‡Á‚‡ ˜Û‚ÒÚ‚ËÚÂÎÌÓÒÚ ÓÍÓÎÓ 80% Ë ÒÔÂˆË-ÙË˜ÌÓÒÚ ÓÍÓÎÓ 75% (10,23). ÑËÒÎÓÍ‡ˆËflÚ‡ ÔÓ ÒÂ‰ËÌÌ‡-Ú‡ ÎËÌËfl ÔÓÍ‡Á‚‡ ÒÔÂˆËÙË˜ÌÓÒÚ ‰Ó 100%, ÌÓ ÌËÒÍ‡˜Û‚ÒÚ‚ËÚÂÎÌÓÒÚ ÔÓ‰ 20%, ÍÓ„‡ÚÓ ÒÂ ‡Á„ÎÂÊ‰‡ Í‡ÚÓ ‡-ÌÂÌ ·ÂÎÂ„. ÑËÒÎÓÍ‡ˆËflÚ‡ ÔÓÌflÍÓ„‡ ÒÂ ËÁÏÂ‚‡ Ë ÒÂ ÓˆÂÌfl-‚‡ ÒÔÓÂ‰ ÓÚÍÎÓÌÂÌËÂÚÓ ÓÚ ÒÂ‰Ì‡Ú‡ ÎËÌËfl (10,23). ë˙ÒÒÂÌÁËÚË‚ÌÓÒÚ ÓÚ ÓÍÓÎÓ 87% Ë ÒÔÂˆËÙË˜ÌÓÒÚ ÓÚ ÓÍÓÎÓ


îË„.4 National Institute of Health Stroke Scale (NIHSS) – Ò˙Í‡ÚÂÌ‚‡Ë‡ÌÚ

1a. çË‚Ó Ì‡ Ò˙ÁÌ‡ÌËÂ(ÍÓÎË˜ÂÒÚ‚ÂÌË Ì‡Û¯ÂÌËfl Ì‡Ò˙ÁÌ‡ÌËÂÚÓ)

1·. ëÚÂÔÂÌ Ì‡ Ò˙ÁÌ‡ÌËÂ(‚˙ÔÓÒË Á‡ ÚÂÍÛ˘Ëfl ÏÂÒÂˆ Ë‚˙Á‡ÒÚÚ‡ Ì‡ Ô‡ˆËÂÌÚ‡)

1‚. ëÚÂÔÂÌ Ì‡ Ò˙ÁÌ‡ÌËÂ (ÍÓÏ‡Ì‰ËÁ‡Ú‚‡flÌÂ Ì‡ Ó˜Ë, ÒÚËÍ‡ÌÂ ËÓÚÔÛÒÍ‡ÌÂ Ì‡ ˙Í‡Ú‡)2. èÓ„ÎÂ‰ÌË Ô‡ÂÁË ÔËıÓËÁÓÌÚ‡ÎÌË Ó˜ÌË ‰‚ËÊÂÌËfl

3. áËÚÂÎÌË Ì‡Û¯ÂÌËfl

4. ãËˆÂ‚‡ Ô‡ÂÁ‡

5. Ñ‚Ë„‡ÚÂÎÌ‡ ‰ÂÈÌÓÒÚ Á‡Á‡‰˙Ê‡ÌÂ Ì‡ ˙ˆÂÚÂ -ÔÓÓÚ‰ÂÎÌÓ

6. Ñ‚Ë„‡ÚÂÎÌ‡ ‰ÂÈÌÓÒÚ Á‡Á‡‰˙Ê‡ÌÂ Ì‡ Í‡Í‡Ú‡ -ÔÓÓÚ‰ÂÎÌÓ

7. ÄÚ‡ÍÒËfl (ÔË ÓÚ‚ÓÂÌË)

8. ëÂÚË‚ÌÓÒÚ

9. ÉÓ‚Ó

10. ÑËÁ‡ÚËfl

11. çÂ„ÎÂÍÚ

á‡·ÂÎÂÊÍ‡

0 – ·Û‰ÌÓÒÚ1 – ÒÓÏÌÓÎÂÌÚÌÓÒÚ2 – ÒÓÔÓ3 – ÍÓÏ‡0 – ÓÚ„Ó‚‡fl ‚flÌÓ Ì‡ ‰‚‡Ú‡ ‚˙ÔÓÒ‡1 – Â‰ËÌËflÚ ÓÚ„Ó‚Ó Â ‚ÂÂÌ ËÎËÌÂ‚˙ÁÏÓÊÌÓÒÚ Á‡ ÍÓÏÛÌËÍ‡ˆËfl ÔÓ‡‰ËËÌÚÛ·‡ˆËfl, ‰ËÁ‡ÚËfl2 – „Â¯Ë ÔË ‰‚‡Ú‡ ‚˙ÔÓÒ‡0 – ËÁÔ˙ÎÌfl‚‡ ‰‚ÂÚÂ ÍÓÏ‡Ì‰Ë1 – ËÁÔ˙ÎÌfl‚‡ Â‰Ì‡Ú‡ ÍÓÏ‡Ì‰‡2 – ÌÂ ËÁÔ˙ÎÌfl‚‡ ÍÓÏ‡Ì‰ËÚÂ0 – ÎËÔÒ‚‡Ú Ô‡ÂÁË1 – ˜‡ÒÚË˜Ì‡ ÔÓ„ÎÂ‰Ì‡ Ô‡ÂÁ‡2 – Ô˙ÎÌ‡ ÔÓ„ÎÂ‰Ì‡ Ô‡ÂÁ‡ ËÎË ÒÔÂ„Ì‡ÚÓÓÚÍÎÓÌÂÌËÂ0 – ÎËÔÒ‚‡Ú Ì‡Û¯ÂÌËfl1 – ˜‡ÒÚË˜Ì‡ ıÂÏË‡ÌÓÔÒËfl2 – Ô˙ÎÌ‡ ıÂÏË‡ÌÓÔÒËfl3 – ÒÎÂÔÓÚ‡ (‚ÍÎ˛˜ËÚÂÎÌÓ ÍÓÓ‚‡)0 – ÎËÔÒ‚‡ Ô‡ÂÁ‡1 – ‰ËÒÍÂÚÌ‡ Ô‡ÂÁ‡ (‡ÒËÏÂÚËfl ÔËÛÒÏËı‚‡ÌÂ, ËÁ„Î‡‰ÂÌ‡ Ì‡ÁÓÎ‡·Ë‡ÎÌ‡ „˙ÌÍ‡)2 – Ô˙ÎÌ‡ ËÎË ÔÓ˜ÚË Ô˙ÎÌ‡ Ô‡ÂÁ‡ Á‡‰ÓÎÌ‡ ÎËˆÂ‚‡ ÔÓÎÓ‚ËÌ‡3 – Ô˙ÎÌ‡ Ô‡ÂÁ‡ Á‡ ‰ÓÎÌ‡ Ë „ÓÌ‡ ÎËˆÂ‚‡ÔÓÎÓ‚ËÌ‡0 – ·ÂÁ ÓÚÔÛÒÍ‡ÌÂ Á‡ 10 ÒÂÍÛÌ‰Ë1 – ÓÚÔÛÒÍ‡ ‚ ‡ÏÍËÚÂ Ì‡ 10 ÒÂÍÛÌ‰Ë2 – Ô‡‰‡ Ì‡ ÎÂ„ÎÓÚÓ Á‡ ÔÓ-Ï‡ÎÍÓ ÓÚ 10 ÒÂÍ.3 – ÌÂ ÔÂÓ‰ÓÎfl‚‡ „‡‚ËÚ‡ˆËflÚ‡4 – ÔÎÂ„Ëfl9* - ‡ÏÔÛÚ‡ˆËfl, ÍÓÌÚ‡ÍÚÛ‡0 – ·ÂÁ ÓÚÔÛÒÍ‡ÌÂ Á‡ 5 ÒÂÍÛÌ‰Ë1 – ÓÚÔÛÒÍ‡ ‚ ‡ÏÍËÚÂ Ì‡ 5 ÒÂÍÛÌ‰Ë2 – Ô‡‰‡ Ì‡ ÎÂ„ÎÓÚÓ Á‡ ÔÓ-Ï‡ÎÍÓ ÓÚ 5 ÒÂÍ.3 – ÌÂ ÔÂÓ‰ÓÎfl‚‡ „‡‚ËÚ‡ˆËflÚ‡4 – ÔÎÂ„Ëfl9* - ‡ÏÔÛÚ‡ˆËfl, ÍÓÌÚ‡ÍÚÛ‡0 – ÎËÔÒ‚‡ ‡Ú‡ÍÒËfl1 – ‡Ú‡ÍÒËfl Á‡ Â‰ËÌ Í‡ÈÌËÍ2 – ‡Ú‡ÍÒËfl Á‡ ÔÓÌÂ 2 Í‡ÈÌËÍ‡9* - ‡ÏÔÛÚ‡ˆËfl, ÍÓÏ‡, ÔÎÂ„Ëfl, ÚÂÊÍ‡Ô‡ÂÁ‡0 – ÌÓÏ‡1 – ÎÂÍ‡ ‰Ó ÛÏÂÂÌ‡ Á‡„Û·‡2 – ÚÂÊÍ‡ ËÎË Ô˙ÎÌ‡ Á‡„Û·‡0 – ÌÓÏ‡1 – ÎÂÍ‡ ‰Ó ÛÏÂÂÌ‡ ‡Ù‡ÁËfl2 – ÚÂÊÍ‡ ‡Ù‡ÁËfl, ÌÂ‚ Á̇ÏÓÊÌ‡ ÍÓÏÛÌËÍ‡ˆËfl3 – ÌflÏ, „ÎÓ·‡ÎÌ‡ ‡Ù‡ÁËfl0 – ÌÓÏ‡1 – ÎÂÍ‡ ‰Ó ÛÏÂÂÌ‡ ‰ËÁ‡ÚËfl2 – ÚÂÊÍ‡ ‰ËÁ‡ÚËfl9* - ÌÂ ÏÓÊÂ ‰‡ ÒÂ ÓÚ˜ÂÚÂ0 – ÌÓÏ‡1 – ÌÂ„ÎÂÍÚ Á‡ Â‰Ì‡ ÏÓ‰‡ÎÌÓÒÚ2 – ÌÂ„ÎÂÍÚ Á‡ ÔÓ‚Â˜Â ÓÚ Â‰Ì‡ÏÓ‰‡ÎÌÓÒÚ9* ÌÂ ÒÂ ÓÚ˜ËÚ‡ ÔË Ó·˘‡Ú‡ ÒÛÏ‡

97% Á‡ÎË˜‡‚‡ÌÂÚÓ Ì‡ ÍÓÚËÍÓ-ÏÂ‰ÛÎ‡ÌËfl ÍÓÌÚ‡ÒÚ ÂÂ‰ËÌ ‰Ó·˙ ÍËÚÂËÈ, ÌÓ ÁÌ‡˜ÂÌËÂÚÓ ÏÛ ÒÂ ÓÒÔÓ‚‡(10,22,23). ãÓÍ‡ÎÌËflÚ ÓÚÓÍ Ò˙˘Ó ÒÂ ÔËÂÏ‡ Á‡ ‰Ó·˙ ÍË-ÚÂËÈ (10). é·‡Á˙Ú Ì‡ ÔÎ˙ÚÌ‡Ú‡ ëåÄ (‚Ë‰ËÏ‡ Ì‡ äíÚÓÏ·ÓÁ‡ Ì‡ å1 ÒÂ„ÏÂÌÚ) Â Ò‚˙Á‡Ì Ò ÔÓ‚Ë¯ÂÌ‡ÒÏ˙ÚÌÓÒÚ (10,23). èÓ‚Ë¯ÂÌ ËÒÍ ËÏ‡ Ë ÔË Í‡ÓÚË‰Ì‡í-ÓÍÎÛÁËfl, Í‡ÍÚÓ Ë ÔË Á‡Òfl„‡ÌÂ Ë Ì‡ ‰Û„Ë Ò˙‰Ó‚Ë ·‡ÒÂÈ-ÌË Ë ÓÚÍÎÓÌÂÌËÂ ÔÓ ıÓËÁÓÌÚ‡Î‡Ú‡ Ì‡ glandula pinealeÌ‡‰ 4 ÏÏ (16). ç‡ÎË˜ËÂÚÓ Ì‡ Ò‚Ó·Ó‰ÌÓ ÔÓÒÚ‡ÌÒÚ‚Ó ‚˜ÂÂÔ‡ (Í‡ÚÓ Ì‡ÔËÏÂ ÍÓÓ‚‡ ‡ÚÓÙËfl) Ì‡Ï‡Îfl‚‡ ËÒÍ‡ÓÚ ‡Á‚ËÚËÂÚÓ Ì‡ Ï‡ÎË„ÌÂÌ ËÌÙ‡ÍÚ (10). ë ÚÓ‚‡ ÏÓÊÂ‰‡ ÒÂ Ó·flÒÌË ˜‡ÒÚË˜ÌÓ Ë ÓÚÌÓÒËÚÂÎÌÓ ÔÓ-ÌËÒÍËfl ËÒÍÔË ÔÓ-‚˙Á‡ÒÚÌË Ô‡ˆËÂÌÚË, Í‡ÍÚÓ Ë ÔË ÔÂÊË‚ÂÎËÚÂÔÂ‰Ë¯ÂÌ ÏÓÁ˙˜ÂÌ ËÌÒÛÎÚ. Ç DESTINY Ò‡ ËÁ·‡ÌË äíÍËÚÂËË Á‡ Á‡Òfl„‡ÌÂ Ì‡ ÔÓÌÂ 2/3 ÓÚ ·‡ÒÂÈÌ‡ Ì‡ ëåÄ,Í‡ÍÚÓ Ë ÔÓÌÂ ˜‡ÒÚË˜ÌÓ Á‡Òfl„‡ÌÂ Ì‡ ·‡Á‡ÎÌËÚÂ fl‰‡ (1).á‡Òfl„‡ÌÂÚÓ Ì‡ ·‡Á‡ÎÌËÚÂ fl‰‡ „Ó‚ÓË Ó·ËÍÌÓ‚ÂÌÓ Á‡ ÓÍ-ÎÛÁËfl Ì‡ Ì‡˜‡ÎÂÌ Û˜‡ÒÚ˙Í Ì‡ „ÓÎflÏ‡ ÏÓÁ˙˜Ì‡ ‡ÚÂËfl,Ú˙È Í‡ÚÓ ı‡ÌÂ˘ËÚÂ „Ë ‡ÚÂËË ËÁÎËÁ‡Ú ÓÚ ÒÂ„ÏÂÌÚËÄ1, Ä2 Ë å1 (25).


ÑÂÍÓÏÔÂÒË‚Ì‡Ú‡ Í‡ÌËÓıËÛ„Ëfl Úfl·‚‡ ‰‡ ÒÂ ÓÒ˙-˘ÂÒÚ‚fl‚‡ ÔË ‚ÒË˜ÍË Ô‡ˆËÂÌÚË Ò ‚ËÒÓÍ ËÒÍ Á‡ Ï‡ÎË„ÌÂÌËÌÙ‡ÍÚ. ífl Úfl·‚‡ ‰‡ ·˙‰Â ÓÒ˙˘ÂÒÚ‚fl‚‡Ì‡ Ï‡ÍÒËÏ‡Î-ÌÓ ‡ÌÓ, Í‡ÚÓ ÓÚÒÚ‡ÌÂÌÓÚÓ ÍÓÒÚÌÓ Î‡Ï·Ó Úfl·‚‡‰‡ ·˙‰Â ‰ÓÒÚ‡Ú˙˜ÌÓ „ÓÎflÏÓ. Ç ·˙‰Â˘Â ÔÂ‰ÒÚÓË ÛÚÓ˜-Ìfl‚‡ÌÂ Ë ÔÓ‰Ó·fl‚‡ÌÂ Ì‡ ‚ÍÎ˛˜‚‡˘ËÚÂ Ë ËÁÍÎ˛˜‚‡˘ËÚÂÍËÚÂËË, Ú˙È Í‡ÚÓ ÔË ÒÂ„‡ ‰ÓÍ‡Á‡ÌËÚÂ ÍÓÏ·ËÌË‡ÌËÍËÚÂËË ÓÚ DECIMAL, HAMLET Ë DESTINY ÒÂ ÔÓ-ÔÛÒÍ‡Ú åàëåÄ, ÔÂ‰ËÏÌÓ ÔË ÔÓ-‚˙Á‡ÒÚÌË Ô‡ˆËÂÌÚËË ÔË Ú‡ÍË‚‡ Ò ‡ÌÌ‡ äí Ë ÎËÔÒ‡ Ì‡ ‰ÂÏ‡ÍË‡Ì ËÌÙ‡ÍÚ.èÂ‰ÒÚÓË Ë ËÁflÒÌfl‚‡ÌÂ Ì‡ ÓÚÌÓ¯ÂÌËflÚ‡ ÚÓÏ·ÓÎËÁ‡-‰Â-ÍÓÏÔÂÒË‚Ì‡ Í‡ÌËÓÚÓÏËfl. èË ÒÂ„‡ ‰ÂÈÒÚ‚‡˘ËÚÂ ÍË-ÚÂËË Í‡Ì‰Ë‰‡ÚËÚÂ Á‡ ‰ÂÍÓÏÔÂÒËfl Úfl·‚‡ ‰‡ ËÏ‡Ú 2/3Á‡Òfl„‡ÌÂ Ì‡ ·‡ÒÂÈÌ‡ Ì‡ ëåÄ, ÍÓÂÚÓ „Ë ËÁÍÎ˛˜‚‡ ÓÚ Í‡Ì-‰Ë‰‡ÚËÚÂ Á‡ ÚÓÏ·ÓÎËÁ‡ ÔÓ Ô‡‚ËÎÓÚÓ Ì‡ Â‰Ì‡Ú‡ ÚÂ-Ú‡. íÂÁË ÍËÚÂËË Ó·‡˜Â, ‚ÂÓflÚÌÓ ˘Â ÔÂÚ˙ÔflÚ ‡Á-‚ËÚËÂ ‚ ·ÎËÁÍËÚÂ „Ó‰ËÌË.

ç‡ Ì‡ÒÚÓfl˘Ëfl ÂÚ‡Ô Ú‡ÁË ÌÂ‚ÓıËÛ„Ë˜Ì‡ Ì‡ÏÂÒ‡ ÂÂ‰Ì‡ ‰ÓÍ‡Á‡Ì‡ Ò ÍÎËÌË˜ÌË ÔÓÛ˜‚‡ÌËfl ÒÔÂ¯Ì‡ ËÌÚÂ‚ÂÌ-ˆËfl ‚ ÌÂ‚ÓÎÓ„ËflÚ‡.

ãàíÖêÄíìêÄ1. Juttler E, Schwab S., Schmiedek P, Unterberg A, Hennerici M, Woitzik J,

Witte S, Jenetzky E, Hacke W. Decompressive Surgery for the Treatment ofMalignant Infarction of the Middle Cerebral Artery (DESTINY). Stroke.2007;38:2518.

2. Jeffrey S. Decompressive Surgery After MCA Stroke Reduces Death,Improves Functional Outcome. Lancet Neurol. Published online February 9,2007.

3. surgical decompression for stroke4. Asil T, Utku U, Balci K. Recovery From Aphasia After Decompressive

Surgery in Patients With Dominant Hemispheric Infarction. Stroke.2005;36:2071

5. Morley NCD, Berge E, Cruz-Flores S, Whittle IR. Surgical decompressionfor cerebral oedema in acute ischaemic stroke. Cochrane Database ofSystematic Reviews 2002, Issue 3. Art. No.: CD003435. DOI:

10.1002/14651858.CD003435.6. Mori K, Aoki A, Yamamoto T, Horinaka N, Maeda M. Aggressive decom-

pressive surgery in patients with massive hemispheric embolic cerebralinfarction associated with severe brain swelling. Acta Neurochir (Wien). 2001;143 (5):483-91; discussion 491-2 11482699

7. Bardutzky J, Schwab S. Antiedema Therapy in Ischemic Stroke. Stroke.2007;38:3084-3094

8. Jaramillo A, Gongora-Rivera F, Labreuche J, Hauw J-J, Amarenco P.Predictors for malignant middle cerebral artery infarctions. NEUROLOGY2006;66:815-820

9. Serena J, Blanco M, Castellanos M, Silva Y, Vivancos J, Moro MA, Leira R,Lizasoain I, Castillo J, Davalos A. The prediction of malignant cerebralinfarction by molecular brain barrier disruption markers. Stroke. 2005; 36:1921–1926.

10. Lam W. W. M, Leung T. W. H, Chu W. C. W, Yeung D. T. K, Wong L. K.S, Poon W. S. Early computed tomography features in extensive middlecerebral artery territory infarct: prediction of survival. Journal of neurology,neurosurgery and psychiatry, 2005, vol. 76, no3, pp. 354-357

11. Lee SJ, Lee KH, Na DG, et al. Multiphasic helical computed tomographypredicts subsequent development of severe brain edema in acute ischemicstroke. Arch Neurol 2004;61:505–509

12. Foerch C, Otto B, Singer OC, Neumann-Haefelin T, Yan B, Berkefeld J,Steinmetz H, Sitzer M. Serum S100B predicts a malignant course of infarc-tion in patients with acute middle cerebral artery occlusion. Stroke. 2004 Sep;35 (9):2160-4 15297628

13. Hofmeijer J, Schepers J, Veldhuis WB, Nicolay K, Kappelle LJ, Bar PR, vander Worp HB. Delayed Decompressive Surgery Increases Apparent DiffusionCoefficient and Improves Peri-Infarct Perfusion in Rats With Space-Occupying Cerebral Infarction. Stroke. 2004;35:1476-1481

14. Dohmen C, Bosche B, Graf R, Staub F, Kracht L, Sobesky J, Neveling M,Brinker G, Heiss WD. Prediction of malignant course in MCA infarction byPET and microdialysis. Stroke. 2003; 34: 2152–2158

15. Schwab S, Hacke W. Surgical decompression of patients with large middlecerebral artery infarcts is effective. Stroke (2003) 34: 2304-5.

16. Wijman CAC. Editorial Comment—Can We Predict Massive Space-Occupying Edema in Large Hemispheric Infarctions? Stroke. 2003;34:1899-1900

17. Thomalla GJ, Kucinski T, Schoder V, Fiehler J, Knab R, Zeumer H, WeillerC, Rother J. Prediction of malignant middle cerebral artery infarction byearly perfusion- and diffusion-weighted magnetic resonance imaging. Stroke.2003; 34: 1892–1899.

18. Doerfler A, Schwab S, Hoffmann TT, Engelhorn T, Forsting M. Combinationof decompressive craniectomy and mild hypothermia ameliorates infarctionvolume after permanent focal ischemia in rats. Stroke. 2001; 32: 2675–2681.

19. Georgiadis D, Schwarz S, Aschoff A, Schwab S. Hemicraniectomy and mod-erate hypothermia in patients with severe ischemic stroke. Stroke. 2002; 33:1584–1588.

20. Leistner S, Boegner F, Marx P, Koennecke H-C. Transtentorial herniationafter unilateral infarction of the anterior cerebral artery. Stroke.2001;32:649–651

21. Gerriets T, Stolz E, Konig S, Babacan S, Fiss I, Jauss M, Kaps M.Sonographic monitoring of midline shift in space-occupying stroke: an earlyoutcome predictor. Stroke. 2001; 32: 442–447

22. Cheung RTF. Computed Tomographic Findings and Prediction of MalignantMiddle Cerebral Artery Infarction. Stroke. 1999;30:2759-2768

23. Haring HP, Dilitz E, Pallua A, Hessenberger G, Kampfl A, Pfausler B,Schmutzhard E. Attenuated corticomedullary contrast: an early cerebral com-puted tomography sign indicating malignant middle cerebral artery infarc-tion: a case-control study. Stroke.. 1999;30:1076–1082

24. Krieger DW, Demchuk AM, Kasner SE, Jauss M, Hantson L. Early clinicaland radiological predictors of fatal brain swelling in ischemic stroke. Stroke.1999; 30: 287–292

25. Rocky C. Saenz DO. The Disappearing Basal Ganglia Sign. Radiology2005;234:242-243

26. Ropper, A.H., Brown R.H. Adams and Victor’s Principles of Neurology – 8thed. McGraw-Hill Companies, Health Progression Division, New York –Toronto, 2005.

Ä‰ÂÒ Á‡ ÍÓÂÒÔÓÌ‰ÂÌˆËfl:

ëÓÙËflìÎ.ÅflÎÓ ÏÓÂ ‹ 8ìåÅÄã “ñ‡Ëˆ‡ âÓ‡ÌÌ‡-àëìã”äÎËÌËÍ‡ ÔÓ ÌÂ‚ÓÎÓ„ËflÑÓˆ.å.åËÎ‡ÌÓ‚‡


SUMMARY

AXURA IN THE TREATMENT OF MODERATE TOSEVERE ALZHEIMER’S DISEASE

St. YanchevaUniversity specialized hospital for active treatment in neu-

rology and psychiatry “St. Naum”Axura (Memantine by Merz) represents an innovative

option for treatment of moderate to severe Alzheimer’s dis-ease. Numerous experimental and preclinical studies and clin-ical trials show that Axura combines beneficial efficacy withgood tolerability. The favourable pharmacoeconomical effectshave a big social importance. The prolonged independency ofthe patients and the decreasing of carers’ distress improve thequality of daily living of both.

êÖáûåÖ

Axura (Memantin Ì‡ Merz) Â ËÌÓ‚‡ÚË‚Ì‡ ÚÂ‡ÔÂ‚ÚË˜-Ì‡ ‚˙ÁÏÓÊÌÓÒÚ Á‡ ÎÂ˜ÂÌËÂ Ì‡ ·ÓÎÌË Ò ÛÏÂÂÌ‡ Ë ÚÂÊÍ‡ÒÚÂÔÂÌ Ì‡ ÅÄ. èËÎ‡„‡ ÒÂ ÛÒÔÂ¯ÌÓ ‚ ÍÎËÌË˜Ì‡Ú‡ Ô‡ÍÚË-Í‡ ÓÚ 20 „Ó‰ËÌË. êÂÁÛÎÚ‡ÚËÚÂ ÓÚ ÏÌÓ„Ó·ÓÈÌËÚÂ ÂÍÒÔÂ-ËÏÂÌÚ‡ÎÌË, ÔÂ‰ÍÎËÌË˜ÌË Ë ÍÎËÌË˜ÌË ÔÓÛ˜‚‡ÌËfl ÔÓÍ‡Á-‚‡Ú, ˜Â ‰Ó·ËflÚ ÚÂ‡ÔÂ‚ÚË˜ÂÌ ÂÁÛÎÚ‡Ú ÒÂ Ò˙˜ÂÚ‡‚‡ ÒÏÌÓ„Ó ‰Ó·˙ ÔÓÙËÎ Ì‡ ·ÂÁÓÔ‡ÒÌÓÒÚ. ÅÎ‡„ÓÔËflÚÌËÚÂÙ‡Ï‡ÍÓËÍÓÌÓÏË˜ÂÒÍË ÂÙÂÍÚË ÓÚ ÔÓ‚ÂÊ‰‡ÌÓÚÓ ÎÂ˜Â-ÌËÂ ËÏ‡Ú Ë „ÓÎflÏÓ ÒÓˆË‡ÎÌÓ ÁÌ‡˜ÂÌËÂ. èÓ-‰˙Î„ÓÚÓ Á‡Ô‡Á-‚‡ÌÂ Ì‡ ÌÂÁ‡‚ËÒËÏÓÒÚÚ‡ Ì‡ ·ÓÎÌËÚÂ Ë Ì‡Ï‡Îfl‚‡ÌÂÚÓ Ì‡‰ËÒÚÂÒ‡ Û Ó·„ËÊ‚‡˘ËÚÂ „Ë, ‚Ó‰flÚ ‰Ó Ò˙˘ÂÒÚ‚ÂÌÓ ÔÓ-‰Ó·fl‚‡ÌÂ Ì‡ Í‡˜ÂÒÚ‚ÓÚÓ Ì‡ ÊË‚ÓÚ Ì‡ Â‰ÌËÚÂ Ë ‰Û„Ë-ÚÂ, ÍÓÂÚÓ Â ÓÒÓ·ÂÌÓ ‚‡ÊÌÓ Á‡ Ò˙‚ÂÏÂÌÌ‡Ú‡ ÏÂ‰ËˆËÌ‡.

ÑÂÏÂÌˆËflÚ‡ Â ÔË‰Ó·ËÚ, ÔÓ„ÂÒË‚ÂÌ, ÏÌÓÊÂÒÚ‚ÂÌ‰ÂÙËˆËÚ Ì‡ ÍÓ„ÌËÚË‚ÌË ÙÛÌÍˆËË Û ·ÓÎÂÌ ‚ Ò˙ÁÌ‡ÌËÂ, ÔËÍÓÈÚÓ ÌÂ ÒÂ Ì‡·Î˛‰‡‚‡ ‰Û„Ó ÔÒËıË˜ÌÓ Á‡·ÓÎfl‚‡ÌÂ.ìÔ‡‰˙Í˙Ú Ì‡ ÍÓ„ÌËÚË‚ÌËÚÂ ÙÛÌÍˆËË Â ‰ÓÒÚ‡Ú˙˜ÌÓ ÁÌ‡-˜ËÏ, Á‡ ‰‡ Ì‡Û¯Ë ÂÊÂ‰ÌÂ‚ÌËÚÂ ‰ÂÈÌÓÒÚË Ì‡ ·ÓÎÌËÚÂ.

ÅÓÎÂÒÚÚ‡ Ì‡ ÄÎˆı‡ÈÏÂ (ÅÄ) Â Ì‡È-˜ÂÒÚÓ ÒÂ˘‡Ì‡Ú‡ÙÓÏ‡ Ì‡ ‰ÂÏÂÌˆËfl (ÔË·ÎËÁËÚÂÎÌÓ 55% ÓÚ ‰ÂÏÂÌˆËËÚÂ‚ ÚÂÚ‡Ú‡ ‚˙Á‡ÒÚ). á‡·ÓÎflÂÏÓÒÚÚ‡ ÓÚ ÅÄ Ì‡‡ÒÚ‚‡ÁÌ‡˜ËÚÂÎÌÓ Ò ‚˙Á‡ÒÚÚ‡, Í‡ÚÓ ÒÂ Û‰‚Ófl‚‡ Á‡ ‚ÒÂÍË 5 „Ó-‰ËÌË ÒÎÂ‰ 60 „Ó‰Ë¯Ì‡ ‚˙Á‡ÒÚ (19, 16). ç‡Â‰ Ò ÂÍÒÔÓÌÂÌ-ˆË‡ÎÌÓÚÓ Ì‡‡ÒÚ‚‡ÌÂ Ì‡ ˜ÂÒÚÓÚ‡Ú‡ Ì‡ ‰ÂÏÂÌˆËflÚ‡ ÒÂÛ‚ÂÎË˜‡‚‡Ú Ë ‡ÁıÓ‰ËÚÂ Á‡ ÎÂ˜ÂÌËÂÚÓ Ë Ó·ÒÎÛÊ‚‡ÌÂÚÓ Ì‡ÚÓÁË ÍÓÌÚËÌ„ÂÌÚ.

è‡ÚÓÙËÁËÓÎÓ„ËflÚ‡ Ì‡ ÅÄ Â ÏÌÓ„ÓÙ‡ÍÚÓÌ‡. äÎËÌË˜-ÌËÚÂ È ÒËÏÔÚÓÏË ‚˙ÁÌËÍ‚‡Ú ‚ ÂÁÛÎÚ‡Ú ÓÚ ıÓÌË˜ÌËÌÂ‚Ó‰Â„ÂÌÂ‡ÚË‚ÌË ÔÓˆÂÒË. Ç ıÓ‰‡ Ì‡ ·ÓÎÂÒÚÚ‡ ‚˙Á-ÌËÍ‚‡ ÍÓÓ‚‡ ‡ÚÓÙËfl Ò˙Ò Á‡„Û·‡ Ì‡ ÌÂ‚ÓÌË Ë ÒËÌ‡ÔÒË,‡Á‚Ë‚‡ ÒÂ „ÎËÓÁ‡. á‡Òfl„‡Ú ÒÂ ÍÓÓ‚ËÚÂ Ë ÒÚË‡Ú‡ÎÌËÚÂÔ˙ÚË˘‡, ÔÓÂÍÚË‡˘Ë ÏÂÊ‰Û ÒÚË‡ÚÛÏ‡, ıËÔÓÍ‡ÏÔ‡ ËÙÓÌÚ‡ÎÌ‡Ú‡ ÍÓ‡ (1).

éÒÌÓ‚ÌË Ï‡ÍÂË Á‡ ÅÄ Ò‡ „‡ÌÛÎÓ‚‡ÍÛÓÎ‡Ì‡Ú‡ ‰Â„Â-ÌÂ‡ˆËfl, ÒÂÌËÎÌËÚÂ ÔÎ‡ÍË, ÌÂ‚ÓÙË·ËÎÂÌËÚÂ ÒÔÎËÚ‡-ÌËfl Ë ‡ÏËÎÓË‰ÌËÚÂ ÓÚÎ‡„‡ÌËfl ÓÍÓÎÓ Ë ‚ ÒÚÂÌËÚÂ Ì‡ ‡-ÚÂËËÚÂ.

ç‡ÎËˆÂ Ò‡ Ì‡Û¯ÂÌËfl ‚ ÓÒÌÓ‚ÌËÚÂ ÌÂ‚ÓÚ‡ÌÒÏËÚÂ-

ÌË ÒËÒÚÂÏË. êÂ‰ÛÍˆËflÚ‡ Ì‡ ıÓÎËÌ‡ˆÂÚËÎÚ‡ÌÒÙÂ‡ÁÌ‡-Ú‡ ‡ÍÚË‚ÌÓÒÚ ‚Ó‰Ë ‰Ó Ì‡Û¯ÂÌ ÒËÌÚÂÁ Ì‡ ‡ˆÂÚËÎıÓÎËÌ ËÁ‡„Û·‡ Ì‡ ıÓÎËÌÂ„Ë˜ÌË ÌÂ‚ÓÌË ‚ ÍÓ‡Ú‡ Ë ·‡Á‡ÎÌÓÚÓ fl‰-Ó Ì‡ Meynert. ÑËÒÙÛÌÍˆËflÚ‡ ‚ „ÎÛÚ‡Ï‡ÚÂ„Ë˜Ì‡Ú‡ ÌÂ‚-ÓÚ‡ÌÒÏËÚÂÌ‡ ÒËÒÚÂÏ‡ Ò˙˘Ó ËÏ‡ ‚‡ÊÌ‡ ÓÎfl ‚ Ô‡ÚÓ-ÎÓ„Ë˜ÌËfl ÔÓˆÂÒ (15, 6). ÑÛ„Ë ÌÓÍÒË Í‡ÚÓ ‡ÏËÎÓË‰ÌË ÓÚ-Î‡„‡ÌËfl Ë ÌÂ‚ÓÙË·ËÎË, ÔÓ‚Ë¯ÂÌË ÍÓÌˆÂÌÚ‡ˆËË Ì‡ Ú‡Û-ÔÓÚÂËÌ, ËÒıÂÏËfl, Ì‡Û¯ÂÌ ÂÌÂ„ËÂÌ ÏÂÚ‡·ÓÎËÁ˙Ï, ÓÍÒË-‰‡ÚË‚ÂÌ ÒÚÂÒ, ‚˙ÁÔ‡ÎÂÌËÂ Ë ‰., Ò˙˘Ó ËÏ‡Ú ÓÚÌÓ¯ÂÌËÂÍ˙Ï Ô‡ÚÓÙËÁËÓÎÓ„ËflÚ‡ Ì‡ ÅÄ. ÑÓÔÛÒÍ‡ ÒÂ, ˜Â Ì‡ÔÂ‰Ì‡Î‡-Ú‡ ‚˙Á‡ÒÚ Ë ÓÍÓÎÌ‡Ú‡ ÒÂ‰‡ Ò˙˘Ó ËÏ‡Ú ÁÌ‡˜ÂÌËÂ. ä‡È-ÌËflÚ ÂÁÛÎÚ‡Ú ÓÚ ‚ÒË˜ÍË ÔÓÏÂÌË Â ÍÎÂÚ˙˜Ì‡ ÒÏ˙Ú.

ç‡ÎËˆÂ Ò‡ ÏÌÓÊÂÒÚ‚Ó ‰ÓÍ‡Á‡ÚÂÎÒÚ‚‡, ˜Â ‰ËÒÙÛÌÍˆËfl-Ú‡ Ì‡ „ÎÛÚ‡Ï‡ÚÂ„Ë˜Ì‡Ú‡ ÌÂ‚ÓÚ‡ÌÒÏËÒËfl, ‚ ˜‡ÒÚ-ÌÓÒÚ Ì‡ N-methyl -D-aspartate (NMDA) ÂˆÂÔÚÓËÚÂ, ÍÓ-ËÚÓ Û˜‡ÒÚ‚‡Ú ‚ ÔÓˆÂÒ‡ Ì‡ Ó·‡·ÓÚÍ‡ Ì‡ ËÌÙÓÏ‡ˆËflÚ‡Ë ÙÓÏË‡ÌÂÚÓ Ì‡ ‰˙Î„ÓÒÓ˜Ì‡Ú‡ Ô‡ÏÂÚ, ‰ÓÔËÌ‡Òfl Í‡Í-ÚÓ Á‡ ÔÓfl‚‡Ú‡ Ì‡ ÒËÏÔÚÓÏËÚÂ, Ú‡Í‡ Ë Á‡ ÔÓ„ÂÒËflÚ‡Ì‡ ÌÂ‚Ó‰Â„ÂÌÂ‡ÚË‚Ì‡Ú‡ ‰ÂÏÂÌˆËfl. ÄÍÓ ‡‚ÌÓ‚ÂÒËÂÚÓÂˆÂÔÚÓ-‡ÍÚË‚Ë‡˘ ÏÂ‰Ë‡ÚÓ ‚ ÌÂ‚ÓÚ‡ÌÒÏËÒËflÚ‡ÒÂ Ì‡Û¯Ë, „ÎÛÚ‡Ï‡Ú-ÔÂ‰ËÁ‚ËÍ‡Ì‡Ú‡ ÂÍÒˆËÚÓÚÓÍÒË˜-ÌÓÒÚ ·Ë‚‡ ÏÂ‰ËË‡Ì‡ ˜ÂÁ NMDA ÂˆÂÔÚÓ‡.

áÌ‡˜ËÚÂÎÌËflÚ ÔÓ„ÂÒ ‚ ËÁflÒÌfl‚‡ÌÂ ÓÎflÚ‡ Ì‡ ‡ÁÎË˜-ÌËÚÂ Ô‡ÚÓÙËÁËÓÎÓ„Ë˜ÌË ÏÂı‡ÌËÁÏË Á‡ ‚˙ÁÌËÍ‚‡ÌÂ Ì‡ ÅÄ‰Ó‚Â‰Â ‰Ó ‡Á‡·ÓÚ‚‡ÌÂÚÓ Ì‡ ÎÂÍ‡ÒÚ‚ÂÌË ÒÂ‰ÒÚ‚‡, ÍÓ-ËÚÓ ‚ ËÁ‚ÂÒÚÌ‡ ÒÚÂÔÂÌ ÏÓ„‡Ú ‰‡ „Ë ÍÓË„Ë‡Ú. NMDAÂˆÂÔÚÓÌËÚÂ ‡ÌÚ‡„ÓÌËÒÚË ÏÓ„‡Ú ‰‡ ÔÂ‰ÓÚ‚‡ÚflÚÔ‡ÚÓÎÓ„Ë˜Ì‡Ú‡ Ò‚˙ıÒÚËÏÛÎ‡ˆËfl Ì‡ NMDA ÂˆÂÔÚÓË-ÚÂ.

Memantine (1-amino-3,5-dimethyl-adamantanehydrochloride) Â ‚‡ÎÚ‡ÊÌÓ-Á‡‚ËÒËÏ, Ò ÛÏÂÂÌ ‡ÙËÌËÚÂÚÌÂÍÓÏÔÂÚÂÚË‚ÂÌ NMDA-ÂˆÂÔÚÓÂÌ ‡ÌÚ‡„ÓÌËÒÚ, ÍÓÈ-ÚÓ ÏÓ‰ÛÎË‡ ÂÙÂÍÚËÚÂ ÓÚ Ô‡ÚÓÎÓ„Ë˜ÌÓ ÔÓ‚Ë¯ÂÌËÚÂÌË‚‡ Ì‡ „ÎÛÚ‡Ï‡Ú‡, ‚Ó‰Â˘Ë ‰Ó ÌÂ‚ÓÌ‡ÎÌ‡ ‰ËÒÙÛÌÍˆËfl(5). è‡ÚÓÎÓ„Ë˜ÌÓÚÓ ‡ÍÚË‚Ë‡ÌÂ Ì‡ NMDA ÂˆÂÔÚÓË-ÚÂ ÔË ıÓÌË˜ÌÓ ÔÓ‚Ë¯ÂÌËÚÂ „ÎÛÚ‡Ï‡ÚÌË ÍÓÌˆÂÌÚ‡-ˆËË Ë ÔÂ‰ËÁ‚ËÍ‡ÌËflÚ ÓÚ ÚÓ‚‡ ÂÍÒˆÂÒË‚ÂÌ Í‡ÎˆËÂ‚ ËÌÙ-ÎÛÍÒ ‚ ÔÓÒÚÒËÌ‡ÔÚË˜ÌËÚÂ ÌÂ‚ÓÌË, ÏÓ„‡Ú ‰‡ ·˙‰‡ÚÔÂ‰ÓÚ‚‡ÚÂÌË ÓÚ Memantine. óÂÁ Ò‚Ófl ÛÌËÍ‡ÎÂÌ ÏÂ-ı‡ÌËÁ˙Ï Ì‡ ‰ÂÈÒÚ‚ËÂ Memantine ·ÎÓÍË‡ ËÁÎË¯ÌËfl „ÎÛ-Ú‡Ï‡Ú ‚ ÒËÌ‡ÔÒ‡ Ë ‚˙ÁÒÚ‡ÌÓ‚fl‚‡ ÙËÁËÓÎÓ„Ë˜Ì‡Ú‡Ú‡ÌÒÏËÒËfl Ì‡ ÒË„Ì‡Î‡. íÓÈ ÓÒË„Ûfl‚‡ Ë ÌÂ‚ÓÌÓÔÓÚÂÍ-ÚË‚ÂÌ ÂÙÂÍÚ (30). ÑÂÈÒÚ‚‡ ÓÚÌÓÒËÚÂÎÌÓ ÒÂÎÂÍÚË‚ÌÓ ‚ÏÓÁ˙Í‡ Ë ËÏ‡ ÒÎ‡·Ë ÔÂËÙÂÌË Ù‡Ï‡ÍÓÎÓ„Ë˜ÌË ÂÙÂÍÚË.

Ç ÔÂÍÎËÌË˜ÌË ËÁÒÎÂ‰‚‡ÌËfl Memantine ÛÔ‡ÊÌfl‚‡Ò‚ÓÂÚÓ ÒÔÂˆËÙË˜ÌÓ ‚ÎËflÌËÂ ‚ ıËÔÓÍ‡ÏÔ‡ Ë ÂÌÚÓËÌ‡ÎÌ‡-Ú‡ ÍÓ‡ Í‡ÚÓ Ì‡Ï‡Îfl‚‡ ÍÓ„ÌËÚË‚ÌËfl Ë ÙÛÌÍˆËÓÌ‡ÎÌËfl‰ÂÙËˆËÚ. Ç ÚÂ‡ÔÂ‚ÚË˜ÌË ‰ÓÁË ÔÓ‰Ó·fl‚‡ Ó·Û˜ËÚÂÎÌË-ÚÂ ÔÓˆÂÒË Ë Á‡Ô‡ÏÂÚfl‚‡ÌÂÚÓ.

Axura (Memantine Ì‡ Merz) ÒÂ ÂÁÓ·Ë‡ Ì‡Ô˙ÎÌÓ ÔËÓ‡ÎÌÓ ÔËÎÓÊÂÌËÂ; ËÏ‡ 100% ·ËÓÌ‡ÎË˜ÌÓÒÚ. Ä·ÒÓ·ˆË-flÚ‡ ÌÂ ÒÂ ‚ÎËflÂ ÓÚ ÔËÂÏ‡ Ì‡ ı‡Ì‡. ÑÓÒÚË„‡ Ï‡ÍÒËÏ‡Î-Ì‡ ÔÎ‡ÁÏÂÌ‡ ÍÓÌˆÂÌÚ‡ˆËfl ÒÎÂ‰ 3-8 ˜‡Ò‡. èË ‰ÓÁ‡ 10-40mg/‰Ì ËÏ‡ ÎËÌÂ‡Ì‡ Ù‡Ï‡ÍÓÍËÌÂÚËÍ‡. Ç 45% ÒÂ Ò‚˙Á‚‡Ò ÔÎ‡ÁÏÂÌËÚÂ ÔÓÚÂËÌË. ê‡ÁÔÓÒÚ‡Ìfl‚‡ ÒÂ ·˙ÁÓ ‚ ÏÓÁ˙-Í‡, ÔÂ‰ËÏÌÓ ‚ ÚÂÏÔÓ‡ÎÌËfl ÎÓ·, ıËÔÓÚ‡Î‡ÏÛÒ‡ Ë ÏÓÒÚ‡


éË„ËÌ‡ÎÌË ÒÚ‡ÚËËAXURA áÄ ãÖóÖçàÖ çÄ ìåÖêÖçÄ äöå íÖÜäÄ îéêåÄ

çÄ ÅéãÖëííÄ çÄ ÄãñïÄâåÖêéí ÖäëèÖêàåÖçíÄ äöå äãàçàóçÄíÄ èêÄäíàäÄ

ëÚ. üÌ˜Â‚‡ìÌË‚ÂÒËÚÂÚÒÍ‡ ÒÔÂˆË‡ÎËÁË‡Ì‡ ·ÓÎÌËˆ‡ Á‡ ‡ÍÚË‚ÌÓ ÎÂ˜ÂÌËÂ ÔÓ ÌÂ‚ÓÎÓ„Ëfl Ë ÔÒËıË‡ÚËfl “ë‚. ç‡ÛÏ”

(36). Å˙ÁÓ ÔÂÏËÌ‡‚‡ Í˙‚ÌÓ-ÏÓÁ˙˜Ì‡Ú‡ ·‡ËÂ‡ Ë ÒÎÂ‰30 min ÒÂ ÓÚÍË‚‡ ‚ ÎËÍ‚Ó‡. ÖÎËÏËÌË‡ ÒÂ ÔÓ˜ÚË Ì‡Ô˙Î-ÌÓ Ò ÛËÌ‡Ú‡ ÔÓ‰ ÙÓÏ‡Ú‡ Ì‡ ÌÂ‡ÍÚË‚ÌË ÏÂÚ‡·ÓÎËÚË. ÇÔËÎ‡„‡ÌËÚÂ ÚÂ‡ÔÂ‚ÚË˜ÌË ÍÓÌˆÂÌÚ‡ˆËË ÒÂ ÔÓÌ‡Òfl‰Ó·Â Ë ÔË˜ËÌfl‚‡ fl‰ÍÓ, ÔÂ‰ËÏÌÓ ÎÂÍË, ÌÂÊÂÎ‡ÌË ÎÂÍ‡-ÒÚ‚ÂÌË Â‡ÍˆËË.

ÖäëèÖêàåÖçíÄãçà àáëãÖÑÇÄçàü

Ç ÏÓ‰ÂÎ Ò ÔÎ˙ıÓ‚Â Axura Á‡˘ËÚ‡‚‡ ÏÓÁ˙Í‡ ÓÚ ·ÂÚ‡-‡ÏËÎÓË‰-ËÌ‰ÛˆË‡Ì‡Ú‡ ‡ÔÓÔÚÓÁ‡ Ë ÓÚ ÌÂ‚ÓÚÓÍÒË˜ÌÓ-ÒÚÚ‡. íÓÈ ÓÚÒÚ‡Ìfl‚‡ ·ÂÚ‡-‡ÏËÎÓË‰-ËÌ‰ÛˆË‡ÌËÚÂ ‰Â-ÙËˆËÚË ‚ ÔÓˆÂÒËÚÂ Ì‡ Á‡Û˜‡‚‡ÌÂÚÓ (22, 33, 34). àÁÒÎÂ‰-‚‡ÌËflÚ‡ Ì‡ C.A. Barnes Ë Ò˙‡‚Ú. (5) ‰ÂÏÓÌÒÚË‡Ú, ˜ÂAxura ÔÓ‰Ó·fl‚‡ ÍÓ„ÌËÚË‚ÌËÚÂ ÛÏÂÌËfl Û ÔÎ˙ıÓ‚Â Ë ÔÓ‚Ë-¯‡‚‡ ÒËÌ‡ÔÚË˜Ì‡Ú‡ ÔÎ‡ÒÚË˜ÌÓÒÚ. èÓÎÓÊËÚÂÎÌËflÚÂÙÂÍÚ e ÔÓÚ‚˙‰ÂÌ Ë ‚ ÔÓ-ÌÓ‚Ë ËÁÒÎÂ‰‚‡ÌËfl (3, 20). åÂ-‰ËÍ‡ÏÂÌÚ˙Ú ÓÒË„Ûfl‚‡ Á‡˘ËÚ‡ ÓÚ ˆËÚÓÚÓÍÒË˜ÌË ‚˙Á-‰ÂÈÒÚ‚Ëfl ‚˙ıÛ ıÓÎËÌÂ„Ë˜ÌËÚÂ ÌÂ‚ÓÌË ‚ nucl. basalismagnocellularis (‡Ì‡ÎÓ„ Ì‡ nucl. basalis Meynert Û ıÓ‡Ú‡),ËÌ‰ÛˆË‡ÌË ÓÚ ıÓÌË˜ÌÓ ÌÂ‚ÓÌ‡ÎÌÓ ‚˙ÁÔ‡ÎÂÌËÂ ÔË ËÌ-ÊÂÍÚË‡ÌÂ Ì‡ ‡ÌÚË„ÂÌ ÎËÔÓÔÓÎËÁ‡ı‡Ë‰ ‚ fl‰ÓÚÓ. ÑÂ„Â-ÌÂ‡ˆËflÚ‡ Ì‡ ıÓÎËÌÂ„Ë˜ÌËÚÂ ÌÂ‚ÓÌË ÒÂ ÔÂ‰ÓÚ‚‡Úfl-‚‡ ÓÚ ÌÂ‚ÓÔÓÚÂÍˆËflÚ‡ Ì‡ NMDA ÂˆÂÔÚÓÌËfl ‡ÌÚ‡-„ÓÌËÒÚ ˜ÂÁ „ÎÛÚ‡Ï‡ÚÂ„Ë˜ÌËÚÂ Ô˙ÚË˘‡ (38). èË invivo ËÌ‰ÛˆË‡Ì‡ ÓÚ ıËÌÓÎËÌÓ‚‡ ÍËÒÂÎËÌ‡ ÌÂ‚Ó‰Â„ÂÌÂ‡-ˆËfl, Axura ÓÔÓÒÂ‰ÒÚ‚‡ ÔÂ‰ÓÚ‚‡Úfl‚‡ÌÂÚÓ Ì‡ ÌÂ‚Ó-Ì‡ÎÌÓÚÓ Û‚ÂÊ‰‡ÌÂ ‚ ıËÔÓÍ‡Ï‡ Ë Á‡Ô‡Á‚‡ÌÂÚÓ Ì‡ ÒÔÓÒÓ·-ÌÓÒÚÚ‡ Á‡ Á‡Û˜‡‚‡ÌÂ (23, 43). íÂÁË ‰‡ÌÌË ÒÂ ‰ÓÔ˙Î‚‡Ú ÓÚÔÓÛ˜‚‡ÌËfl, ‚ ÍÓËÚÓ ÏÂ‰ËÍ‡ÏÂÌÚ˙Ú ÔÓ‰ÔÓÏ‡„‡ ÌÂ‚Ó„Â-ÌÂÁ‡Ú‡ ‚ ıËÔÓÍ‡ÏÔ‡ Ì‡ ‚˙Á‡ÒÚÌË ÔÎ˙ıÓ‚Â. èÓ‚Ë¯‡‚‡ ÒÂ·ÓflÚ Ì‡ ÔÓÎËÙÂ‡ÚË‚ÌËÚÂ ÍÎÂÚÍË, Ì‡ ÌÓ‚ËÚÂ ÌÂ‚ÓÌËË Ì‡ ‡‰Ë‡ÎÌË, ÔÓ‰Ó·ÌË Ì‡ „ÎËfl, ÍÎÂÚÍË ‚ ıËÔÓÍ‡ÏÔ‡ (24).éÒ‚ÂÌ ÚÓ‚‡, ‚ ÏÓ‰ÂÎ ÓÚ ÔÎ˙ıÓ‚Â, Á‡Ô‡Á‚‡ ıÓÎËÌÂ„Ë˜ÌËÚÂÌÂ‚ÌË ÓÍÓÌ˜‡ÌËfl Ë Á‡Ô‡Á‚‡ ÔÓÁÌ‡‚‡ÚÂÎÌËÚÂ ÒÔÓÒÓ·ÌÓÒ-ÚË. èË ÚÂ‡ÔÂ‚ÚË˜ÌË ÔÎ‡ÁÏÂÌË ÒÚÓÈÌÓÒÚË Axura ÔÂ-‰ÓÚ‚‡Úfl‚‡ NMDA-ËÌ‰ÛˆË‡ÌËÚÂ ÌÂ‚ÓÌ‡ÎÌË ÎÂÁËË ‚nucl. basalis magnocellularis Ì‡ ÔÎ˙ıÓ‚Â. í‡Í‡ ÒÂ Ò˙ı‡Ìfl-‚‡Ú ÔÓˆÂÒ˙Ú Ì‡ ÒËÌÚÂÁË‡ÌÂ Ì‡ ‡ˆÂÚËÎıÓÎËÌ Ë ÒÔÓÒÓ·-ÌÓÒÚÚ‡ Á‡ Á‡Û˜‡‚‡ÌÂ (6, 7, 33, 34). åÂ‰ËÍ‡ÏÂÌÚ˙Ú Ò˙˘ÓÚ‡Í‡ Á‡˘ËÚ‡‚‡ ÌÂ‚ÓÌËÚÂ ÓÚ ‚ÚÓË˜Ì‡ ÏËÚÓıÓÌ‰Ë‡Î-Ì‡ ‰ËÒÙÛÌÍˆËfl Ë ÓÚ Ò‚˙Á‡ÌËÚÂ Ò ÌÂfl ÌÂ‚Ó‰Â„ÂÌÂ‡ÚË‚-ÌË ÔÓÏÂÌË (35, 29). èÂ‚ÂÌˆËfl Ì‡ ÒÚÛÍÚÛÌË Ë ÙÛÌÍˆË-ÓÌ‡ÎÌË Ì‡Û¯ÂÌËfl Â Ì‡·Î˛‰‡‚‡Ì‡ Ë ÔË ÂÍÒÔÂËÏÂÌÚ‡ÎÌÓÔÂ‰ËÁ‚ËÍ‡ÌË ıËÔÓÍÒËfl Ë ıËÔÓ„ÎËÍÂÏËfl (30).

äãàçàóçé èêàãéÜÖçàÖ

ÑÓÍ‡Á‡ÌÓ Â, ˜Â ·ÂÁ ÚÂ‡ÔËfl ‚ÎÓ¯‡‚‡ÌÂÚÓ Ì‡ ·ÓÎÌËÚÂ ÒÅÄ ÒÂ ËÁÏÂ‚‡ Ò 3-4 ÚÓ˜ÍË „Ó‰Ë¯ÌÓ ÔË MMSE. íÂ ÏÌÓ„Ó·˙ÁÓ Ì‡‚ÎËÁ‡Ú ‚ ÔÓ-ÚÂÊÍËÚÂ ÒÚ‡‰ËË Ì‡ ·ÓÎÂÒÚÚ‡. ãÂ-˜ÂÌËÂÚÓ Ì‡ ‚ÒÂÍË Â‰ËÌ ·ÓÎÂÌ Úfl·‚‡ ‰‡ ·˙‰Â ËÌ‰Ë‚Ë‰Û‡-ÎËÁË‡ÌÓ Ë ‰‡ ÒÂ ÓÒÌÓ‚‡‚‡ Ì‡ ËÌÚÂ„Ë‡Ì‡ ÍÓÌˆÂÔˆËfl (12).ñÂÎÚ‡ Ì‡ ÎÂ˜ÂÌËÂÚÓ (ÒÔÓÂ‰ ÒÚ‡‰Ëfl Ì‡ ·ÓÎÂÒÚÚ‡) Â ‰‡ÔÓ‰Ó·Ë Ë ÒÚ‡·ËÎËÁË‡ ÂÊÂ‰ÌÂ‚Ì‡Ú‡ ‰ÂÈÌÓÒÚ Ì‡ ËÌ‰Ë‚Ë-‰‡, ‰‡ Á‡·‡‚Ë ËÎË ‰‡ Â‰ÛˆË‡ Á‡ ÔÓ-‰˙Î„Ó ‚ÂÏÂ ÌÂÓ·ıÓ‰Ë-ÏÓÒÚÚ‡ ÓÚ Ó·„ËÊ‚‡ÌÂÚÓ ÏÛ Ë ‰‡ Ì‡Ï‡ÎË ·ÂÏÂÚÓ Ì‡Ó·ÒÎÛÊ‚‡˘Ëfl ÔÂÒÓÌ‡Î.

ëÎÂ‰ ÏÌÓÊÂÒÚ‚ÓÚÓ ÂÍÒÔÂËÏÂÌÚ‡ÎÌË ËÁÒÎÂ‰‚‡ÌËflÂÙËÍ‡ÒÌÓÒÚÚ‡ Ë ÔÓÌÓÒËÏÓÒÚÚ‡ Ì‡ Axura Ò‡ ‰ÓÍ‡Á‡ÌË Ë ÒÂ‰Ëˆ‡ ÍÎËÌË˜ÌË ÔÓÛ˜‚‡ÌËfl, ÔÓ‚Â‰ÂÌË ‚ Ò˙ÓÚ‚ÂÚÒÚ‚ËÂÒ ÏÂÊ‰ÛÌ‡Ó‰ÌËÚÂ Ô‡‚ËÎ‡ Ì‡ ‰Ó·‡Ú‡ ÍÎËÌË˜Ì‡ Ô‡Í-ÚËÍ‡. èËÎ‡„‡ÌË Ò‡ ‚‡ÎË‰ËÁË‡ÌË Ë Ò˙Ó·‡ÁÂÌË Ò ÔÓ-ÚÂÊ-ÍÓÚÓ Ò˙ÒÚÓflÌËÂ Ì‡ ·ÓÎÌËÚÂ ÚÂÒÚÓ‚Â, ÍÓËÚÓ Ò‡ ‰ÓÒ-Ú‡Ú˙˜ÌÓ ˜Û‚ÒÚ‚ËÚÂÎÌË, Á‡ ‰‡ ÒÂ ÓˆÂÌË ÂÁÛÎÚ‡Ú˙Ú ÓÚÎÂ˜ÂÌËÂÚÓ.

èÓÛ˜‚‡ÌÂÚÓ Ì‡ B. Reisberg Ë Ò˙‡‚Ú. (27) Â ÏÛÎÚËˆÂ-ÌÚÓ‚Ó, ÔÎ‡ˆÂ·Ó ÍÓÌÚÓÎË‡ÌÓ, ‡Ì‰ÓÏËÁË‡ÌÓ, ‰‚ÓÈÌÓ

ÒÎflÔÓ, Ò Ô‡‡ÎÂÎÌË „ÛÔË. ÇÍÎ˛˜ÂÌË Ò‡ 252 ‡Ï·ÛÎ‡ÚÓÌÓ·ÓÎÌË. ëÎÂ‰ 1 ÏÂÒ. Á‡ ÚËÚË‡ÌÂ Ì‡ ‰ÓÁ‡Ú‡, ·ÓÎÌËÚÂ ÔÓ-ÎÛ˜‡‚‡Ú 20 mg Axura ËÎË ÔÎ‡ˆÂ·Ó ‚ ÔÓ‰˙ÎÊÂÌËÂ Ì‡ 6 ÏÂÒ.á‡‚˙¯ËÎËÚÂ ÛÒÔÂ¯ÌÓ Ô˙‚‡Ú‡ Ù‡Á‡ Ò‡ ‚ÍÎ˛˜ÂÌË ‚ 6 ÏÂ-ÒÂ˜Ì‡ ÓÚÍËÚ‡ Ù‡Á‡. Ç Í‡fl Ì‡ ÔÓÛ˜‚‡ÌÂÚÓ Â ÛÒÚ‡ÌÓ‚Â-ÌÓ, ˜Â Axura Á‡·‡‚fl Ò˙˘ÂÒÚ‚ÂÌÓ ÔÓ„ÂÒËflÚ‡ Ì‡ ·ÓÎÂÒÚ-Ú‡ Ë ËÏ‡ ÁÌ‡˜ËÚÂÎÌÓ ÔÓ-‰Ó·˙ ÂÙÂÍÚ ÓÚ ÔÎ‡ˆÂ·Ó ÔÓ ÓÚ-ÌÓ¯ÂÌËÂ Ì‡ ÓÒÌÓ‚ÌËÚÂ ÍÎËÌË˜ÌË ÒËÏÔÚÓÏË – „ÎÓ·‡ÎÂÌÍÎËÌË˜ÂÌ ÒÚ‡ÚÛÒ (CIBIC +), ÙÛÌÍˆËÓÌ‡ÎÌË ÛÏÂÌËfl ËÂÊÂ‰ÌÂ‚ÌË ‰ÂÈÌÓÒÚË (ADCS-ADL 19, FAST) Ë ÔÓÁÌ‡‚‡-ÚÂÎÌË ÒÔÓÒÓ·ÌÓÒÚË (SIB). ê‡ÁÎËÍËÚÂ, ÍÓËÚÓ Ì‡ÒÚ˙Ô‚‡ÚÓ˘Â Ì‡ 1-Ëfl ÏÂÒÂˆ, ÒÂ Á‡‰˙Ê‡Ú ‰Ó Í‡fl Ì‡ ÔÓÛ˜‚‡ÌÂÚÓ.Ç ‡ÍÚË‚Ì‡Ú‡ „ÛÔ‡ ·ÓflÚ Ì‡ “ÂÒÔÓÌ‰ÂËÚÂ” Â 2-3 Ô˙ÚËÔÓ-„ÓÎflÏ, ‚ Ò‡‚ÌÂÌËÂ Ò ÍÓÌÚÓÎÌ‡Ú‡ (<0.001). åÌÓ„ÓÔÓ‚Â˜Â Ò‡ ÓÚÔ‡‰Ì‡ÎËÚÂ ÔÓ‡‰Ë ÌÂÊÂÎ‡ÌË Â‡ÍˆËË Ë ÎËÔÒ‡Ì‡ ÂÙÂÍÚ ‚ „ÛÔ‡Ú‡ Ì‡ ÔÎ‡ˆÂ·Ó (Ò˙ÓÚ‚ÂÚÌÓ 33% Ë 23%).éÚ˜ËÚ‡Ú ÒÂ (21) Ò˙˘ÂÒÚ‚ÂÌË ÔÓÏÂÌË Ë ‚ ÔÓ‚Â‰ÂÌËÂÚÓ(NPI).

ÖÙËÍ‡ÒÌÓÒÚÚ‡ Ë ÔÓÌÓÒËÏÓÒÚÚ‡ Ì‡ Axura Ò‡ ËÁÒÎÂ‰‚‡-ÌË ‚ ÏÛÎÚËˆÂÌÚÓ‚Ó, ÔÎ‡ˆÂ·Ó ÍÓÌÚÓÎË‡ÌÓ, ‡Ì‰ÓÏËÁË-‡ÌÓ, ‰‚ÓÈÌÓ ÒÎflÔÓ, Ò Ô‡‡ÎÂÎÌË „ÛÔË ÔÓÛ˜‚‡ÌÂ, ‚ ÍÓÂÚÓÒ‡ ‚ÍÎ˛˜ÂÌË 166 ËÌÒÚËÚÛˆËÓÌ‡ÎËÁË‡ÌË ·ÓÎÌË Ò ÚÂÊÍ‡‰Â„ÂÌÂ‡ÚË‚Ì‡ ËÎË Ò˙‰Ó‚‡ ‰ÂÏÂÌˆËfl (42). à ‚ ÚÓ‚‡ ÔÓÛ˜-‚‡ÌÂ Ó˘Â Ì‡ 4 ÒÂ‰ÏËˆ‡ ÎÂÍÛ‚‡ÌËÚÂ Ò Axura (10 mg/‰Ì)ËÏ‡Ú ÒË„ÌËÙËÍ‡ÌÚÌÓ ÔÓ-‰Ó·Ë ÂÁÛÎÚ‡ÚË ÔÓ ÓÚÌÓ¯ÂÌËÂÌ‡ Á‡‚ËÒËÏÓÒÚÚ‡ ÓÚ Ó·ÒÎÛÊ‚‡ÌÂ, ÓˆÂÌfl‚‡Ì‡ ÓÚ ÎÂÍ‡Ë ËÒÂÒÚË (CGI-C, BGP) ‰‚Ë„‡ÚÂÎÌËÚÂ ÙÛÌÍˆËË, Ò‚˙Á‡ÌË-ÚÂ Ò ÂÊÂ‰ÌÂ‚ËÂÚÓ ‰ÂÈÌÓÒÚË Ë ÒÓˆË‡ÎÌÓÚÓ ÔÓ‚Â‰ÂÌËÂ. ÇÂÁÛÎÚ‡Ú Ì‡ ÚÓ‚‡ 65% ÓÚ ÎÂÍÛ‚‡ÌËÚÂ ÒÂ ÌÛÊ‰‡flÚ ÓÚÔÓ-Ï‡ÎÍÓ Ó·„ËÊ‚‡ÌÂ, ‚ Ò‡‚ÌÂÌËÂ Ò ÚÂÁË Ì‡ ÔÎ‡ˆÂ·Ó(40%). Ç ÔÓ‰„ÛÔ‡Ú‡ Ò ÅÄ, ÔË ÎÂÍÛ‚‡ÌËÚÂ Ò Axura, ·Ó-flÚ Ì‡ “ÂÒÔÓÌ‰ÂËÚÂ” (61%) Â ÏÌÓ„Ó ÔÓ-„ÓÎflÏ (26%) ÓÚÚÓÁË ÔË ÍÓÌÚÓÎËÚÂ (9).

àÌÚÂÂÒ Á‡ ÍÎËÌË˜Ì‡Ú‡ Ô‡ÍÚËÍ‡ ÔÂ‰ÒÚ‡‚Îfl‚‡ ÔÓ-Û˜‚‡ÌÂÚÓ, ÔË ÍÓÂÚÓ ÂÙËÍ‡ÒÌÓÒÚÚ‡ Ë ÔÓÌÓÒËÏÓÒÚÚ‡ Ì‡Axura Ò‡ ËÁÒÎÂ‰‚‡ÌË ÔË ·ÓÎÌË Ò ÛÏÂÂÌ‡ ‰Ó ÚÂÊÍ‡ ÅÄ,ÍÓËÚÓ ‚Â˜Â Ò‡ Ì‡ ÒÚ‡·ËÎÌ‡ ‰ÓÁ‡ Donepezil (31). íÓ‚‡ ÂÏÛÎÚËˆÂÌÚÓ‚Ó, ÔÎ‡ˆÂ·Ó ÍÓÌÚÓÎË‡ÌÓ, ‡Ì‰ÓÏËÁË‡ÌÓ,‰‚ÓÈÌÓ ÒÎflÔÓ Ò Ô‡‡ÎÂÎÌË „ÛÔË ÔÓÛ˜‚‡ÌÂ. ÅÓÎÌËÚÂ Ò‡ÔÓÎÛ˜‡‚‡ÎË Donepezil ‚ ÔÂ‰¯ÂÒÚ‚‡˘ËÚÂ 6 ÏÂÒ., Í‡ÚÓÔÂÁ ÔÓÒÎÂ‰ÌËÚÂ 3 ÏÂÒ. ‰ÓÁ‡Ú‡ ÌÂ Â ÔÓÏÂÌflÌ‡. ê‡Ì‰ÓÏË-ÁË‡ÌËÚÂ 404 Ô‡ˆËÂÌÚË ÔÓÎÛ˜‡‚‡Ú 20 mg/‰Ì Axura ËÎËÔÎ‡ˆÂ·Ó Á‡ 24 ÒÂ‰ÏËˆË. èÂÁ ˆflÎÓÚÓ ‚ÂÏÂ ÓÒÚ‡‚‡Ú Ì‡Ò˙˘‡Ú‡ ‰ÓÁ‡ Donepezil. Ç Í‡fl Ì‡ ÔÓÛ˜‚‡ÌÂÚÓ ÓÚÔ‡‰Ì‡-ÎËÚÂ ÓÚ „ÛÔ‡Ú‡ Ì‡ Axura Ò‡ ÔÓ-Ï‡ÎÍÓ (15%) ÓÚ ÚÂÁË Ì‡ÔÎ‡ˆÂ·Ó (25%). Axura ‚Ó‰Ë ‰Ó ÒÚ‡ÚËÒÚË˜ÂÒÍË ÁÌ‡˜ËÏÓÔÓ‰Ó·ÂÌËÂ Ì‡ ‚ÒË˜ÍË ËÁÒÎÂ‰‚‡ÌË ÔÓÍ‡Á‡ÚÂÎË, ‚ Ò‡‚ÌÂÌËÂÒ ÍÓÌÚÓÎÌ‡Ú‡ „ÛÔ‡. á‡·‡‚ÂÌ Â ÚÂÏÔ˙Ú Ì‡ ÛÔ‡‰˙Í‡ Ì‡‰ÂÈÌÓÒÚËÚÂ, Ò‚˙Á‡ÌË Ò ÂÊÂ‰ÌÂ‚ËÂÚÓ (ADCS-ADL 19,BGP-care dependency). éÚ˜ËÚ‡ ÒÂ ÔÓ‰Ó·ÂÌËÂ Ì‡ ÔÓÁÌ‡‚‡-ÚÂÎÌËÚÂ ÙÛÌÍˆËË (SIB), Ì‡ „ÎÓ·‡ÎÌËfl ÍÎËÌË˜ÂÌ ÒÚ‡ÚÛÒ(CIBIC +) Ë ÔÓ‚Â‰ÂÌËÂÚÓ (NPI). èÓÏÂÌËÚÂ Á‡ÔÓ˜‚‡ÚÓ˘Â Ì‡ 4-Ú‡ ÒÂ‰ÏËˆ‡ Ë ÒÂ Á‡‰˙Ê‡Ú ‰Ó Í‡fl Ì‡ ÔÓÛ˜‚‡-ÌÂÚÓ (28 ÒÂ‰Ï.).

ë˙˘ÂÒÚ‚ÂÌÓ ÔÓ‰Ó·ÂÌËÂ ‚ ÔÓ‚Â‰ÂÌËÂÚÓ Ë ÙÛÌÍˆËÓÌ‡Î-ÌËÚÂ ÒÔÓÒÓ·ÌÓÒÚË Ì‡ ·ÓÎÌËÚÂ Ò˙Ó·˘‡‚‡Ú Ë S. Gauthier ËÒ˙‡‚Ú. (13, 14, 8, 2).

ÖÙËÍ‡ÒÌÓÒÚÚ‡ Ë ·ÂÁÓÔ‡ÒÌÓÒÚÚ‡ Ì‡ Axura ÔË ‡Ï·ÛÎ‡-ÚÓÌÓ ·ÓÎÌË Ò‡ ËÁÒÎÂ‰‚‡ÌË ˜ÂÁ ÏÂÚ‡ ‡Ì‡ÎËÁ Ì‡ ‰‡ÌÌËÚÂÓÚ 6 ÔÎ‡ˆÂ·Ó-ÍÓÌÚÓÎË‡ÌË, ‡Ì‰ÓÏËÁË‡ÌË, ‰‚ÓÈÌÓ ÒÎÂ-ÔË, ÏÛÎÚËˆÂÌÚÓ‚Ë, Ò Ô‡‡ÎÂÎÌË „ÛÔË ÍÎËÌË˜ÌË ÔÓÛ˜‚‡-ÌËfl. Ç ÚË ÓÚ Úflı Ò‡ ‚ÍÎ˛˜ÂÌË ·ÓÎÌË Ò ÛÏÂÂÌ‡ Í˙ÏÚÂÊÍ‡ Ë ‚ 3 – Ò ÎÂÍ‡ Í˙Ï ÛÏÂÂÌ‡ ÒÚÂÔÂÌ Ì‡ ÅÄ. åÂ‰ËÍ‡-ÏÂÌÚ˙Ú Â ÔËÎ‡„‡Ì ÔË Ô‡ˆËÂÌÚË Ì‡‰ 50 „Ó‰. ‚˙‚ ÙËÍÒË-‡Ì‡ ÔÓ‰‰˙Ê‡˘‡ ‰ÓÁ‡ 20 mg/‰Ì, ‚ ÔÓ‰˙ÎÊÂÌËÂ Ì‡ 6 ÏÂ-ÒÂˆ‡, ÒÎÂ‰ 4 ÒÂ‰ÏË˜ÂÌ ÚËÚË‡˘ ÔÂËÓ‰ (25, 4, 27, 31).

Ç ÏÂÚ‡-‡Ì‡ÎËÁ‡ Á‡ Ó·˘‡ ÓˆÂÌÍ‡ Ì‡ ÂÙÂÍÚ‡ ÓÚ Axura


Í‡ÚÓ ÏÓÌÓÚÂ‡ÔËfl ËÎË ‚ ÍÓÏ·ËÌ‡ˆËfl Ò Donepezil Ò‡‚ÍÎ˛˜ÂÌË 2311 ·ÓÎÌË. ÖÙËÍ‡ÒÌÓÒÚÚ‡ Â ÓˆÂÌfl‚‡Ì‡ ‚ ÔÓ‰„-ÛÔ‡ ÓÚ 1826 ·ÓÎÌË Ò ÛÏÂÂÌ‡ ‰Ó ÚÂÊÍ‡ ÅÄ (MMSE<20)– 959 Ì‡ ÎÂ˜ÂÌËÂ Ò Axura Ë 867 – Ì‡ ÔÎ‡ˆÂ·Ó. ÑÓÍ‡Á‚‡ ÒÂÒÚ‡ÚËÒÚË˜ÂÒÍË ÁÌ‡˜ËÏÓ ÔÓ-‰Ó·˙ ÂÙÂÍÚ Ì‡ Axura ÓÚÚÓÁË Ì‡ ÔÎ‡ˆÂ·Ó ‚ ÚËÚÂ ÓÒÌÓ‚ÌË Ó·Î‡ÒÚË – Ó·˘ ÒÚ‡ÚÛÒ(CIBIC +, p<0.0001), ÍÓ„ÌËˆËfl (ADAS-cog/SIB, p<0.00001)Ë ÙÛÌÍˆËË (ADCS-ADL23/19, p=0.0007). íÂÁË ‰‡ÌÌË Ò‡ÔÓÚ‚˙‰ÂÌË ÓÚ ÔÓ-ÌÓ‚Ë ÔÓÛ˜‚‡ÌËfl (41, 10). ÇÎËflÌËÂÚÓ‚˙ıÛ ÌflÍÓË ÓÚ ÒËÏÔÚÓÏËÚÂ Â ‰ÓÁÓÁ‡‚ËÒËÏÓ (17). Ç˙Á-ÏÓÊÌÓ Â ÍÓÏ·ËÌË‡ÌÓÚÓ ÏÛ ÔËÎÓÊÂÌËÂ Ò Donepezil. ë˙-Ó·˘‡‚‡ ÒÂ, ˜Â ÔÂÏËÌ‡‚‡ÌÂÚÓ Ì‡ ·ÓÎÌËÚÂ ÓÚ ÎÂ˜ÂÌËÂ ÒDonepezil Í˙Ï Axura ÒÂ ÔÓÌ‡Òfl ‰Ó·Â (32). êÂÁÛÎÚ‡ÚËÚÂÓÚ ÚÂÁË ÔÓÛ˜‚‡ÌËfl ‰Ó‚ÂÊ‰‡Ú ‰Ó ‡Á¯Ëfl‚‡ÌÂ Ì‡ ËÌ‰Ë-Í‡ˆËËÚÂ Á‡ ÔËÎÓÊÂÌËÂ Ì‡ Axura Ë ÔË ·ÓÎÌË Ò ÛÏÂÂÌ‡ ‰ÓÚÂÊÍ‡ ÅÄ (MMSE<20).

èÓ„ÂÒËflÚ‡ Ì‡ ·ÓÎÂÒÚÚ‡ ÓÚ ÛÏÂÂÌ‡ Í˙Ï ÚÂÊÍ‡ÒÚÂÔÂÌ ÔÂ‰ÒÚ‡‚Îfl‚‡ ÚÂÊ˙Í ‰ËÒÚÂÒ Á‡ ·ÎËÁÍËÚÂ Ë Ì‡-Î‡„‡ Ì‡ÒÚ‡Ìfl‚‡ÌÂÚÓ Ì‡ ·ÓÎÌËÚÂ ‚ ÒÔÂˆË‡ÎËÁË‡ÌË Á‡‚Â‰Â-ÌËfl. Ç ÚÓÁË ÒÏËÒ˙Î ÒÚ‡·ËÎËÁË‡ÌÂÚÓ Ì‡ Ò˙ÒÚÓflÌËÂÚÓ ËÔÂ‚ÂÌˆËflÚ‡ Ì‡ ‚ÎÓ¯‡‚‡ÌÂÚÓ Ò‡ ÓÒÌÓ‚Ì‡ Á‡‰‡˜‡ Ì‡ ÎÂ˜Â-ÌËÂÚÓ.

á‡ ˆÂÎÚ‡ Ò‡ Ó·‡·ÓÚÂÌË ‰‡ÌÌËÚÂ ÓÚ 6-ÚÂ ÔÓÛ˜‚‡ÌËfl(37, 10). “èÓ‰˜ÂÚ‡ÌÓ ÍÎËÌË˜ÌÓ ‚ÎÓ¯‡‚‡ÌÂ” ÒÂ ÔËÂÏ‡ÔË ÒÌËÊ‡‚‡ÌÂ Ò > 4 ÚÓ˜ÍË Ì‡ ADAS-cog ËÎË Ò > 5 ÚÓ˜ÍËÌ‡ SIB, ÔÎ˛Ò ‚ÎÓ¯‡‚‡ÌÂ Ì‡ ÌflÍÓË ÔÓÍ‡Á‡ÚÂÎË ÓÚ ADCS-ADL23/29 Ë CIBIC+. Ñ‚ÓÈÌÓ ÔÓ‚Â˜Â ·ÓÎÌË ÒÂ ‚ÎÓ¯‡‚‡Ú ‚„ÛÔ‡Ú‡ Ì‡ ÔÎ‡ˆÂ·Ó ‚ Ò‡‚ÌÂÌËÂ Ò ÚÂÁË Ì‡ Axura (Ò˙ÓÚ‚.21% Ë 11%, <0.001). Axura ÔÂ‚˙ÁıÓÊ‰‡ ÔÎ‡ˆÂ·Ó Ë ÔÓ ÓÚ-ÌÓ¯ÂÌËÂ Ì‡ ÔÂ‚ÂÌˆËflÚ‡ Ì‡ ‚ÎÓ¯‡‚‡ÌÂÚÓ ‚ ÚËÚÂ ÓÒ-ÌÓ‚ÌË „ÛÔË ÒËÏÔÚÓÏË (Ó·˘ ÒÚ‡ÚÛÒ, ÍÓ„ÌËˆËfl Ë ÙÛÌÍˆË-ÓÌË‡ÌÂ). åÂ‰ËÍ‡ÏÂÌÚ˙Ú ÓÚÒÓ˜‚‡ ‚ ÔÓ-„ÓÎflÏ ·ÓÈ ·ÓÎ-ÌË ÔÂ‰ËÁ‚ËÍ‚‡˘ËÚÂ ‰ËÒÚÂÒ ÒËÏÔÚÓÏË.

ëÔÂˆË‡ÎÌ‡ Ó·‡·ÓÚÍ‡ Ì‡ ‰‡ÌÌËÚÂ Á‡ ÔÓÏflÌ‡ ‚ ÓÚ‰ÂÎ-ÌËÚÂ ÒËÏÔÚÓÏË (27, 8) ÔÓÍ‡Á‚‡, ˜Â Axura ÔÓ‰Ó·fl‚‡ ÒÚ‡-ÚËÒÚË˜ÂÒÍË ÁÌ‡˜ËÏÓ ÙÛÌÍˆËÓÌË‡ÌÂÚÓ Ì‡ ·ÓÎÌËÚÂ. íÓÁËÂÙÂÍÚ Â Ì‡È-ËÁ‡ÁÂÌ ÔÓ ÓÚÌÓ¯ÂÌËÂ Ì‡ ÔÓ‚ÂÊ‰‡ÌÂ Ì‡ ‡Á-„Ó‚Ó, ÔÓ˜ËÒÚ‚‡ÌÂ Ì‡ Ï‡Ò‡Ú‡, ÔË·Ë‡ÌÂ Ì‡ ÓÚÔ‡‰˙ˆËÚÂ,ËÁÔÓÎÁ‚‡ÌÂ Ì‡ ÚÂÎÂÙÓÌ, ËÁÎËÁ‡ÌÂ ËÁ‚˙Ì ‰ÓÏ‡, Ò‡ÏÓÓ·ÒÎÛÊ-‚‡ÌÂ (ËÁÔ‡‚flÌÂ, Ó·ÎË˜‡ÌÂ, ÔËÂÌÂ, ÔÓÎÁ‚‡ÌÂ Ì‡ ÚÓ‡ÎÂÚÌ‡-Ú‡).

èËÎ‡„‡ÌÂÚÓ Ì‡ Axura Í‡ÚÓ ÏÓÌÓÚÂ‡ÔËfl ËÎË ‚ ÍÓÏ-·ËÌ‡ˆËfl Ò Donepezil (27, 13, 31) ÓÍ‡Á‚‡ ÔÓ-‰Ó·˙ ÂÙÂÍÚ‚˙ıÛ ÔÓ‚Â‰ÂÌËÂÚÓ Ì‡ ·ÓÎÌËÚÂ (NPI) Ë ÔÓ-ÒÔÂˆË‡ÎÌÓ ‚˙-ıÛ ‚˙Á·Û‰‡Ú‡ Ë ‡„ÂÒËflÚ‡ (<0.05). é˘Â ÔÓ‚Â˜Â, „ÓÎflÏ·ÓÈ ÓÚ ·ÓÎÌËÚÂ Ò‡ ÓÒÚ‡Ì‡ÎË ‡ÒËÏÔÚÓÏÌË ÔÓ ÓÚÌÓ¯Â-ÌËÂ Ì‡ ‡„ÂÒËflÚ‡, ‚˙Á·Û‰ËÏÓÒÚÚ‡ Ë ÌÓ˘ÌÓÚÓ ÔÓ‚Â‰ÂÌËÂ.

Axura Á‡Ô‡Á‚‡ ÂÙÂÍÚË‚ÌÓÒÚÚ‡ ÒË Ë ÔË ÔÓ‰˙ÎÊËÎÓÚÓÓ˘Â 6 ÏÂÒÂˆ‡ ÎÂ˜ÂÌËÂ Ì‡ 175 ·ÓÎÌË, ÍÓËÚÓ Ò‡ ‚ÍÎ˛˜ÂÌË ‚ÓÚ‚ÓÂÌ‡Ú‡ Ù‡Á‡ (28). ÅÎ‡„ÓÔËflÚÌËflÚ ÂÙÂÍÚ ‚˙ıÛÚËÚÂ ÓÒÌÓ‚ÌË „ÛÔË ÒËÏÔÚÓÏË, ÍÓÈÚÓ ÒÂ ËÁ‡Áfl‚‡ ‚ Á‡-·‡‚flÌÂ Ì‡ ‚ÎÓ¯‡‚‡ÌÂÚÓ, ÒÂ Á‡Ô‡Á‚‡ ‰Ó Í‡fl Ì‡ ÎÂ˜Â·ÌËflÔÂËÓ‰. çÂ˘Ó ÔÓ‚Â˜Â, ÔÓ‰Ó·ÂÌ ÂÙÂÍÚ ÒÂ Ì‡·Î˛‰‡‚‡ Ë ÔË·ÓÎÌËÚÂ, ÍÓËÚÓ Ò‡ ÔÂ‚ÍÎ˛˜ÂÌË ÓÚ ÔÎ‡ˆÂ·Ó Ì‡ ÏÂ‰ËÍ‡-ÏÂÌÚ‡.

êÂ‰Ëˆ‡ Ù‡Ï‡ÍÓËÍÓÌÓÏË˜ÂÒÍË ÔÓÛ˜‚‡ÌËfl (40, 26, 18)ÔÓÍ‡Á‚‡Ú, ˜Â ÎÂ˜ÂÌËÂÚÓ Ò Axura ÔË ·ÓÎÌË Ò ÛÏÂÂÌ‡ Í˙ÏÚÂÊÍ‡ ÅÄ Â Ë ËÍÓÌÓÏË˜ÂÒÍË ÂÙÂÍÚË‚ÌÓ. ëÌËÊ‡‚‡ÌÂÚÓ Ì‡ÙËÌ‡ÌÒÓ‚ËÚÂ ‡ÁıÓ‰Ë Ë‰‚‡ ÓÚ Á‡Ô‡Á‚‡ÌÂ ÌÂÁ‡‚ËÒËÏÓÒÚÚ‡Ì‡ ·ÓÎÌËÚÂ Á‡ ÔÓ-‰˙Î˙„ ÔÂËÓ‰ Ë ÓÚÎ‡„‡ÌÂ ‚˙‚ ‚ÂÏÂÚÓ Ì‡ÌÂÓ·ıÓ‰ËÏÓÒÚÚ‡ ÓÚ Ì‡ÒÚ‡Ìfl‚‡ÌÂÚÓ ËÏ ‚ ÒÔÂˆË‡ÎËÁË‡-ÌË Á‡‚Â‰ÂÌËfl.


Axura (Memantin Ì‡ Merz) Â ËÌÓ‚‡ÚË‚Ì‡ ÚÂ‡ÔÂ‚ÚË˜-Ì‡ ‚˙ÁÏÓÊÌÓÒÚ Á‡ ÎÂ˜ÂÌËÂ Ì‡ ·ÓÎÌË Ò ÛÏÂÂÌ‡ Ë ÚÂÊÍ‡

ÒÚÂÔÂÌ Ì‡ ÅÄ. èËÎ‡„‡ ÒÂ ÛÒÔÂ¯ÌÓ ‚ ÍÎËÌË˜Ì‡Ú‡ Ô‡ÍÚË-Í‡ ÓÚ 20 „Ó‰ËÌË. êÂÁÛÎÚ‡ÚËÚÂ ÓÚ ÏÌÓ„Ó·ÓÈÌËÚÂ ÂÍÒÔÂ-ËÏÂÌÚ‡ÎÌË, ÔÂ‰ÍÎËÌË˜ÌË Ë ÍÎËÌË˜ÌË ÔÓÛ˜‚‡ÌËfl ÔÓÍ‡Á-‚‡Ú, ˜Â ‰Ó·ËflÚ ÚÂ‡ÔÂ‚ÚË˜ÂÌ ÂÁÛÎÚ‡Ú ÒÂ Ò˙˜ÂÚ‡‚‡ ÒÏÌÓ„Ó ‰Ó·˙ ÔÓÙËÎ Ì‡ ·ÂÁÓÔ‡ÒÌÓÒÚ. ÅÎ‡„ÓÔËflÚÌËÚÂÙ‡Ï‡ÍÓËÍÓÌÓÏË˜ÂÒÍË ÂÙÂÍÚË ÓÚ ÔÓ‚ÂÊ‰‡ÌÓÚÓ ÎÂ˜Â-ÌËÂ ËÏ‡Ú Ë „ÓÎflÏÓ ÒÓˆË‡ÎÌÓ ÁÌ‡˜ÂÌËÂ. èÓ-‰˙Î„ÓÚÓ Á‡Ô‡Á-‚‡ÌÂ Ì‡ ÌÂÁ‡‚ËÒËÏÓÒÚÚ‡ Ì‡ ·ÓÎÌËÚÂ Ë Ì‡Ï‡Îfl‚‡ÌÂÚÓ Ì‡‰ËÒÚÂÒ‡ Û Ó·„ËÊ‚‡˘ËÚÂ „Ë, ‚Ó‰flÚ ‰Ó Ò˙˘ÂÒÚ‚ÂÌÓ ÔÓ-‰Ó·fl‚‡ÌÂ Ì‡ Í‡˜ÂÒÚ‚ÓÚÓ Ì‡ ÊË‚ÓÚ Ì‡ Â‰ÌËÚÂ Ë ‰Û„Ë-ÚÂ, ÍÓÂÚÓ Â ÓÒÓ·ÂÌÓ ‚‡ÊÌÓ Á‡ Ò˙‚ÂÏÂÌÌ‡Ú‡ ÏÂ‰ËˆËÌ‡.á‡˘ÓÚÓ “·˙‰Â˘ÂÚÓ Ì‡ Â‰ÌÓ Ó·˘ÂÒÚ‚Ó ÏÓÊÂ ‰‡ ÒÂ ÔÂ‰-‚Ë‰Ë ÓÚ Ì‡˜ËÌ‡, ÔÓ ÍÓÈÚÓ ÒÂ „ËÊË Á‡ ÏÎ‡‰ËÚÂ, ‡ Í‡˜ÂÒÚ-‚ÓÚÓ Ì‡ ˆË‚ËÎËÁ‡ˆËflÚ‡ ÏÓÊÂ ‰‡ ÒÂ ÓˆÂÌË ÔÓ Ì‡˜ËÌ‡, ÔÓÍÓÈÚÓ ÒÂ „ËÊË Á‡ ‚˙Á‡ÒÚÌËÚÂ” (D.P. Moynihan, Familyand Nation).

ãàíÖêÄíìêÄ1. üÌ˜Â‚‡, ëÚ., í‡ÈÍÓ‚, ã. ÑÂÏÂÌˆËË. Ç: çÂ‚ÓÎÓ„Ëfl (åËÎ‡ÌÓ‚, à‚., üÌ˜Â-

‚‡, ëÚ., Â‰.), ëÓÙËfl, åÂ‰. Ë ÙËÁÍ.,2008, 635-645.2. Alva, G., Farlow, M.R., Porsteinsson, A., Graham, S.M. Update of memantin

safety in short-and long-term treatment of mild to severe Alzheimer’s dis-ease. Eur J Neurol, Abstracts of the 11th Congress of the EFNS, Brussels,Belgium, Aug 25-28, 2007, P1088, 51.

3. Bachurin S, Tkachenko S, Baskin I, et al. Neuroprotective and cognition-enhancing properties of MK-801 flexible analogs. Structure-activity relation-ships. Ann N Y Acad Sci, 2001, 939: 219-236.

4. Backchine S, Pascual-Gangnant L, Loft H. Results of a randomised, placebo-controlled 6-month study of memantine in the treatment of mild to moderateAlzheimer’s disease in Europe. Poster presented at the 9th Congress of theEuropean Federation of Neurological Societies (EFNS), Athens, Greece.September, 2005, 17-20.

5. Barnes, C.A., Danysz, W., Parsons, C.G. Effects of the uncompetitive NMDAreceptor antagonist memantine on hyppocampal, long-term potentiation,short-term exploratory modulation and spatial memory in awake, freely mov-ing rats. Eur J Neurosci, 1996, 8, 565-571.

6. Danysz, W., Mobius, H.J., Parsons, C.G. et al. Memantine provides neuropro-tection in animal models at therapeutically relevant doses. Neurobiol Aging,2000a, 21, S242.

7. Danysz, W., Parsons, C.G., Mobius, H.J. et al. Neuroprotective and sympto-matological action of memantine relevant for Alzheimer’s disease – an uni-fied hypothesis on the mechanism of action. Neurotox Res, 2000b, 2, 85-97.

8. Doody, R., Wirth, Y., Schmitt, F., Mobius, H.J. Specific functional effects ofmemantine treatment in patients with moderate to severe Alzheimer’s dis-ease. Dement Geriatr Cogn Disord, 2004, 18, 227-232.

9. EPAR (European Public Assessment Report) AXURA,www.eudra.org/humans/epar/axura, 2002.

10. EPAR (European Public Assessment Report) AXURA,www.eudra.org/humans/epar/axura,2006.

11. Forest Laboratories Inc., Clinical Trial Registry.12. Fusgen, I. Demenz – Praktischer Umgang mit Hirnleistungsstorungen. Urban

und Vogel, Munchen, 4th ed., 2001. 13. Gauthier, S., Wirth, Y., Mobius, H.J. Effects of memantine on behavioural

symptoms in Alzheimer’s disease patients: an analysis of theNeuropsychiatric Inventory (NPI) data of two randomised, controlled studies.Int J Geriatr Psychiatry, 2005, 20, 459-464.

14. Gauthier, S., Cummings, J.L., Loft, H. Specific benefits of memantine onbehavioural symptoms in patients with moderate to severe Alzheimer’s dis-ease (AD). Eur J Neurol, Abstracts of the 11th Congress of the EFNS,Brussels, Belgium, Aug 25-28, 2007, P1079, 49.

15. Greenamyre JT, Young AB. Excitatory amino acids and Alzheimer’s disease.Neurobiol Aging, 1989, 10: 593-602.

16. Henderson AS, Jorm AF. Definition and epidemiology of dementia: a review.In: Maj M, Sartorius N (eds), Dementia. John Wiley & Sons Ltd, Chichester,UK, 2000, 1-33.

17. Homma, A., Kitamura, S., Yoshimura, I. Efficacy of memantine in patientswith moderately severe to severe Alzheimer’s disease in Japan (Dose-findingstudy). Eur J Neurol, Abstracts of the 11th Congress of the EFNS, Brussels,Belgium, Aug 25-28, 2007, P1081, 49.

18. Jones, R.W., McCrone, P., Guilhaume, C. Cost effectiveness of memantine inAlzheimer’s disease. An analysis based on a probabilistic Markov Modelfrom a UK perspective. Drugs Aging, 2004, 21(9):607-620.

19. Lobo A, Launer LJ, Fratiglioni L, et al. Prevalence of dementia and majorsubtypes in Europe: a collaborative study of population-based cohorts.Neurology 54, 2000, Supp 5, 4-9.

20. Lukoyanov NV, Paula-Barbosa MM. Memantine, but not dizocilpine, amelio-rates cognitive deficits in adult rats withdrawn from chronic ingestion ofalcohol. Neurosci Lett, 2001, 309: 45-48.

21. Merz Pharmaceuticals, Data on file. 22. Miguel-Hidalgo, J.J., Alvares, X.A., Cacabelos, R., Quack, G.

Neuroprotection by memantine against neurodegeneration induced by beta-amyloid (1-40). Brain Res, 2002, 958, 210-221.

23. Misztal, M., Frankiewicz, T., Parsons, C.G., Danysz, W. Learning deficitsinduced by chronic intraventricular infusion of quinolinic acid – protection byMK-801 and memantine. Eur J Pharmacol, 1996, 296, 1-8.

24. Nacher, J., Alonso-Llosa,G., Rossell, D., McEwen, B.S. MNDA receptorantagonist treatment increases the production of new neurons in the aged rathyppocampus. Neurobiol Aging, 2003, 24, 273-284.

25. Peskind ER, Potkin SG, Pomara N, et al. Memantine monotherapy is effec-tive and safe for the treatment of mild to moderate Alzheimer’s disease: arandomized controlled trial. Poster presented at the American Association for


Geriatric Psychiatry 17th Annual Meeting, Baltimore, MD. February, 2004,21-24.

26. Plosker, G.L., Lyseng-Williamson, K.A. Memantine: a pharmacoeconomicreview of its use in moderate-to-severe Alzheimer’s disease.Pharmacoeconomics, 2005, 23(2), 193-206.

27. Reisberg, B., Doody, R., Stoffler, A. et al. Memantine in moderate-to-severeAlzheimer’s disease. N Engl J Med, 2003, 348, 1333-1341.

28. Reisberg, B., Doody, R., Stoffler, A. et al. A 24-week open-label extensionstudy of memantine in moderate to severe Alzheimer’s disease. Arch Neurol,2006, 63, 49-54.

29. Schulz, J.B., Matthews, R.T., Henshaw, D.R., Beal, M.F. Neuroprotectivestrategies for the treatment of lesions produced by mitochondrial toxins:implications for neurodegenerative diseases. Neuroscience, 1996, 71, 1043-1048.

30. Stieg, P.E., Sathi, S., Warach, S., Le, D.A., Lipton, S.A. Neuroprotection bythe NMDA receptor-associated open-chanel blocker memantine in a pho-tothrombotic model of cerebral focal ischemia in neonatal rat. Eur JPharmacol, 1999, 30, 375 (1-3),115-120.

31. Tariot, P.N., Farlow, M.R., Grossberg, G.T. et al. Memantine treatment inpatients with moderate to severe Alzheimer disease already receivingdonepezil. JAMA, 2004, 291(3), 317-324.

32. Waldemar, G., Koner, A., Hyvarinen, M. et al. Tolerability of switching fromdonepezil to memantine treatment in patients with moderate to severeAlzheimer’s disease. Poster presented at the 7th International Conference onAlzheimer’s and Parkinson,s disease (AD/PD), Sorrento, Italy, March 9-13, 2005.

33. Wenk, G.L., Danysz, W., Mobley, S.L. Investigations of neurotoxicity and neu-roprotection within the nucleus basalis of the rat. Brain Res, 1994, 655, 7-11.

34. Wenk, G.L., Danysz, W., Mobley, S.L. MK-801, memantine and amantadineshow neuroprotective activity in the nucleus basalis magnocellularis. Eur JPharmacol, 1995, 267-270.

35. Wenk, G.L., Danysz, W., Roice, D.D. The effects of mitochondrial failure uponholinergic toxicity in the nucleus basalis. NeuroReport, 1996, 7, 1453-1456.

36. Wesemann, W., Sturm, G., Funfgeld, E.W. Distribution and metabolism ofthe potential anti-parkison drug memantine in the human. J Neural TransmSuppl.16, 1980, 143-148.

37. Wilkinsin D, Andersen HF. Prevention of the worsening of clinical symptomsin moderate to severe Alzheimer’s disease in patients treated with meman-tine. Poster presented at the 9th International Geneva/Springfield Symposiumon Advances in Alzheimer Therapy; April, 2006, 19-22.

38. Willard, L.B., Haus-Wegrzyniak, B., Danysz, W., Wenk, G.L. The cytotoxici-ty of chronic neuroinflamation upon basal forebrain cholinergic neurons of

rats can be attenuated by glutamatergic antagonism or cyclooxygenase-2 inhi-bition. Exp Brain Res 2000, 134, 58-65.

39. Wimo, A., Wetterholm, A.L., Mastey, V., Winblad, B. Evaluation of healthcareresource utilisation and caregiver time in anti-dementia drug trials – a quanti-tative battery. In: Health economics of dementia (Wimo, A., Jonsson, B.,Karlsson, G., Winblad, B. ,eds.), Chichester, UK: John Wiley, 1998, 465-499.

40. Wimo, A., Winbland, B., Stoffler, A. et al. Resource utilisation and costanalysis of memantine in patients with moderate to severe Alzheimer’s dis-ease. Pharmacoeconomics, 2003, 21(3), 327-340.

41. Winblad, B., Jones, R.W., Wirth, Y. et al. Memantine in moderate to severeAlzheimer’s disease: a meta-analysis of randomized clinical trials. Poster pre-sented at the 9th International Geneva/Springfield Symposium on Advancesin Alzheimer Therapy, April 19-22, 2006.

42. Winblad, B., Poritis, N. Memantine in severe dementia: results of the M-BEST study (Benefit and Efficacy in Severely demented patients duringTreatment with Memantine). Int J Geriat Psychiatry, 1999, 14, 135-146.

43. Zajaczkowski, W., Quack, G., Danysz, W. Infusion of (+)-MK-801 andmemantine –contrasting effects on radial maze learning in rats with entorhi-nal cortex lesion. Eur J Pharmacol, 1996, 296, 239-246.

Ä‰ÂÒ Á‡ ÍÓÂÒÔÓÌ‰ÂÌˆËfl: èÓÙ. ‰- ëÚÂÙÍ‡ üÌ˜Â‚‡, ‰ÏÌ ëÓÙËfl 1113ÛÎ. “Ñ- ã. êÛÒÂ‚” ‹ 1ìÌË‚ÂÒËÚÂÚÒÍ‡ ÒÔÂˆË‡ÎËÁË‡Ì‡ ·ÓÎÌËˆ‡ Á‡ ‡ÍÚË‚ÌÓ ÎÂ-˜ÂÌËÂ ÔÓ ÌÂ‚ÓÎÓ„Ëfl Ë ÔÒËıË‡ÚËfl “ë‚. ç‡ÛÏ”

Address for correspondence: Prof. Dr. Stefka Yancheva, DScSofia 11131 Dr. L. Russev, Str.University specialized hospital for active treatment in neu-rology and psychiatry “St. Naum”


éË„ËÌ‡ÎÌË ÒÚ‡ÚËËÖèàãÖèëàü à åéáöóçà äÄÇÖêçéåà

ê. èÓÔÓ‚, ü. ÖÌ˜Â‚, ä. åËÌÍËÌ, Ç. ÅÛÒ‡ÒÍË, ä. êÓÏ‡ÌÒÍË, å. ÇËÍÚÓÓ‚‡äÎËÌËÍ‡ ÔÓ ÌÂ‚ÓıËÛ„Ëfl, ìåÅÄã “ë‚. à‚. êËÎÒÍË”,

åÂ‰ËˆËÌÒÍË ìÌË‚ÂÒËÚÂÚ – ëÓÙËfl

SUMMARY

BRAIN CAVERNOMAS AND EPILEPSYR. Popov, Y. Enchev, K. Minkin, V. Bussarsky, K. Romansky,

M. ViktorovaClinic of Neurosurgery,University Hospital “Sv. Iv. Rilsky”,

Medical University – SofiaThe autors analyze group of 160 patients who had surgical

treatment for histologically proven cavernous angiomas of thebrain at one institution for 22 years (1986-2007). Long-termfollow up was made for 6 to 226 months (mean 67 months).121 of the patients had supratentorial and 39 infratentoriallesions. Epilepsy suffered 82 people - 51.3% of all and 67.8%of supratentorial. All of the patiens were operated on usingmicrosurgical technic supported in 8 cases with frame stereo-taxy and neuronavigation in 23 cases. If malformations werein non-eloquent zone not only lesionectomy, but surroundedhemosiderin – weighted tissue was removed. There were onlytwo lethal cases (2.4%) and 9.9% morbidity. Long-term fol-low up evaluation has shown gradual improvement and per-manent morbidity 3.3%. Mean Karnofsky score was 90. Goodresults (seizure free or decreased) were achieved in 89%. Theautors conclude that brain cavernomas with epilepsy could besurgically removed even in critical regions of the brain withgood long-term results. Image – guided techniques are usefulwith high intraoperative accuracy in surgery of the caver-nomas.

KEY WORDS: cavernoma, vascular malformation, epilepsy, microsurgical excision.

êÖáûåÖ

Ä‚ÚÓËÚÂ ÔÂ‰ÒÚ‡‚flÚ ‡Ì‡ÎËÁ Ì‡ 160 Ô‡ˆËÂÌÚË ÓÔÂË-‡ÌË Á‡ ÏÓÁ˙˜ÌË Í‡‚ÂÌÓÏË Á‡ 22 „Ó‰Ë¯ÂÌ ÔÂËÓ‰ (1986-2007). éÚ Úflı 121 Ò‡ ËÏ‡ÎË ÒÛÔ‡ÚÂÌÚÓË‡ÎÌË Ë 39 ËÌÙ-‡ÚÂÌÚÓË‡ÎÌË ÎÂÁËË. ÖÔËÎÂÔÚË˜ÌË ÔÓfl‚Ë Ò‡ ËÏ‡ÎË 82‰Û¯Ë – 51.3% ÓÚ ‚ÒË˜ÍË ·ÓÎÌË Ë 67.8% ÓÚ ÒÛÔ‡ÚÂÌÚÓ-Ë‡ÎÌËÚÂ. Ñ˙Î„ÓÒÓ˜ÌÓ ÔÓÛ˜‚‡ÌÂ Â ÔÓ‚Â‰ÂÌÓ Á‡ ÒÓÍ ÓÚ6 ‰Ó 226 ÏÂÒ. (Ò. 67 ÏÂÒ.). ÇÒË˜ÍË ·ÓÎÌË Ò‡ ÓÔÂË‡ÌË ÒÏËÍÓıËÛ„Ë˜Ì‡ ÚÂıÌËÍ‡, ‡ÏÍÓ‚‡ ÒÚÂÂÓÚ‡ÍÒËfl Â ËÁ-ÔÓÎÁ‚‡Ì‡ ‚ 8 ÒÎÛ˜‡fl Ë ÌÂ‚ÓÌ‡‚Ë„‡ˆËfl ÔË 23 ÓÚ Úflı. äÓ-„‡ÚÓ Ï‡ÎÙÓÏ‡ˆËËÚÂ ÌÂ Ò‡ ·ËÎË ‡ÁÔÓÎÓÊÂÌË ‚˙‚ ÙÛÌÍ-ˆËÓÌ‡ÎÌÓ ‚‡ÊÌË ÁÓÌË Â ËÁ‚˙¯‚‡Ì‡ ÌÂ Ò‡ÏÓ ÎÂÁËÓÌÂÍÚÓ-ÏËfl, ÌÓ Ë ‡ÒÔË‡ˆËfl Ì‡ ÓÍÓÎÌ‡Ú‡ Ú˙Í‡Ì, Ì‡ÚÓ‚‡ÂÌ‡ Ò ıÂ-ÏÓÒË‰ÂËÌ. ëÏ˙ÚÌÓÒÚÚ‡ ‚˙ÁÎËÁ‡ Ì‡ 2.4% (2 ÒÎÛ˜‡fl) Á‡ÚÂÁË Ò ÂÔËÎÂÔÒËfl Ë ÔÂËÓÔÂ‡ÚË‚ÂÌ ÏÓ·Ë‰ËÚÂÚ 9.9%.Ñ˙Î„ÓÒÓ˜ÌÓÚÓ ÔÓÒÎÂ‰fl‚‡ÌÂ ÔÓÍ‡Á‚‡ ÔÓÒÚÂÔÂÌÌÓ ÔÓ‰Ó·-ÂÌËÂ Ì‡ ‰ÂÙËˆËÚ‡ ÔË ÔÓ‚Â˜ÂÚÓ ÒÎÛ˜‡Ë Ë Ú‡ÈÌËflÚÏÓ·Ë‰ËÚÂÚ ‚˙ÁÎËÁ‡ Ì‡ 3.3%. ëÂ‰ÌËflÚ ÂÁÛÎÚ‡Ú ÔÓÒÍ‡Î‡Ú‡ Ì‡ Karnofsky Á‡ „ÛÔ‡Ú‡ ·ÓÎÌË Ò ÂÔËÎÂÔÒËfl Â 90.ÑÓ·Ó ÔÓ‚ÎËfl‚‡ÌÂ Ì‡ ÔËÔ‡‰˙ˆËÚÂ (ÔÂÍ‡Úfl‚‡ÌÂ ËÎË Ì‡-Ï‡Îfl‚‡ÌÂ ÔÓ ˜ÂÒÚÓÚ‡ Ë ÚÂÊÂÒÚ) ÒÂ ÓÚ˜ËÚ‡ ÔË 89% ÓÚÔ‡ˆËÂÌÚËÚÂ. Ä‚ÚÓËÚÂ Á‡ÍÎ˛˜‡‚‡Ú, ˜Â ÏÓÁ˙˜ÌËÚÂ Í‡-‚ÂÌÓÏË ÔÓÚË˜‡˘Ë Ò ÂÔËÎÂÔÒËfl ÏÓ„‡Ú ‰‡ ·˙‰‡Ú ÛÒÔÂ¯-ÌÓ ÓÚÒÚ‡ÌÂÌË ‰ÓË ÍÓ„‡ÚÓ Ò‡ ÎÓÍ‡ÎËÁË‡ÌË ‚˙‚ ÙÛÌÍˆË-ÓÌ‡ÎÌÓ ‚‡ÊÌË ÁÓÌË. çËÒÍËflÚ Í˙ÒÂÌ ÏÓ·Ë‰ËÚÂÚ, Í‡ÍÚÓË ‰Ó·ÓÚÓ ÔÓ‚ÎËfl‚‡ÌÂ Ì‡ ÔËÔ‡‰˙ˆËÚÂ Á‡Â‰ÌÓ Ò ‚ËÒÓÍ Â-ÁÛÎÚ‡Ú ÔÓ Karnofsky ÒÍ‡Î‡Ú‡ ÓÚ ‰˙Î„ÓÒÓ˜ÌÓÚÓ ÔÓÒÎÂ-‰fl‚‡ÌÂ Ò‡ ‰ÓÒÚ‡Ú˙˜ÂÌ ‡„ÛÏÂÌÚ Á‡ ‚ËÒÓÍ‡ ıËÛ„Ë˜Ì‡‡ÍÚË‚ÌÓÒÚ Í˙Ï Ú‡ÍË‚‡ ÎÂÁËË.

äãûóéÇà Ñìåà: Í‡‚ÂÌÓÏ, Ò˙‰Ó‚‡ Ï‡ÎÙÓÏ‡ˆËfl,ÂÔËÎÂÔÒËfl, ÏËÍÓıËÛ„Ë˜Ì‡ ÂÍÒˆËÁËfl.

ÇöÇÖÑÖçàÖ

åÓÁ˙˜ÌËÚÂ Í‡‚ÂÌÓÁÌË Ò˙‰Ó‚Ë Ï‡ÎÙÓÏ‡ˆËË (äëå)ÔÂ‰ÒÚ‡‚Îfl‚‡Ú ÙÓÏ‡ˆËË ÓÚ ‰ËÎ‡ÚË‡ÌË Ò˙‰Ó‚Â (Í‡‚Â-ÌË), ˜ËËÚÓ ÒÚÂÌË Ò‡ Ò˙ÒÚ‡‚ÂÌË ÓÚ ÂÌ‰ÓÚÂÎÂÌ ÒÎÓÈ ·ÂÁÛ˜‡ÒÚËÂ Ì‡ ÏÂ‰Ëfl Ë ‡‰‚ÂÌÚËˆËfl, ·ÂÁ ÏÓÁ˙˜Ì‡ ÒÛ·ÒÚ‡ÌˆËfl‚ Ò˙‰Ó‚Ëfl ÍÓÌ‚ÓÎÛÚ 2, 9. óÂÒÚÓ Ò˙‰˙Ê‡Ú ÚÓÏ·Ë Ò ‡Á-ÎË˜Ì‡ ‰‡‚ÌÓÒÚ Ë ÒÚÂÔÂÌ Ì‡ Ó„‡ÌËÁ‡ˆËfl, Í‡ÍÚÓ Ë ÓÚÎ‡„‡-ÌÂ Ì‡ ıË‡ÎËÌ Ë Í‡ÎˆËÙËÍ‡ÚË. èÓ‚Ú‡fl˘ËÚÂ ÒÂ ÂÔËÁÓ‰ËÓÚ ıÂÏÓ‡„ËË Ë ÚÓÏ·ÓÁË ‚Ó‰flÚ ‰Ó ÓÚÎ‡„‡ÌÂ Ì‡ ıÂÏÓÒË-‰ÂËÌ Ë ‰Û„Ë ıÂÏÓ„ÎÓ·ËÌ ‰Â„‡‰‡ˆËÓÌÌË ÔÓ‰ÛÍÚË ‚ Ò˙-ÒÂ‰Ì‡Ú‡ Ì‡ Í‡‚ÂÌÓÏ‡ ÏÓÁ˙˜Ì‡ Ú˙Í‡Ì. íÂ Ò‡ ‰Ó·ÓÍ‡˜Â-ÒÚ‚ÂÌË Ò˙‰Ó‚Ë ÎÂÁËË Ò˙Ò ÒÍÎÓÌÌÓÒÚ Í˙Ï Í˙‚ÂÌÂ, ÍÓËÚÓÏÓ„‡Ú ‰‡ ÒÂ ÒÂ˘Ì‡Ú ‚˙‚ ‚ÒflÍ‡ ˜‡ÒÚ Ì‡ ÏÓÁ˙Í‡. íÓ‚‡Ó·ÛÒÎ‡‚fl ËÁÍÎ˛˜ËÚÂÎÌÓÚÓ ‡ÁÌÓÓ·‡ÁËÂ ÓÚ ÍÎËÌË˜ÌËÔÓfl‚Ë, ‰Ë‡„ÌÓÒÚË˜ÌË ÔÓ·ÎÂÏË, ÎÂ˜Â·ÌË ÏÂÚÓ‰Ë, Í‡ÍÚÓË ıËÛ„Ë˜ÌË ‰ÓÒÚ˙ÔË Ë ÚÂıÌËÍË Á‡ ÚflıÌÓÚÓ ÓÚÒÚ‡Ìfl-‚‡ÌÂ. Ç ÌflÍÓË Ò‡‚ÌËÚÂÎÌË ÔÛ·ÎËÍ‡ˆËË ˜ÂÒÚÓÚ‡Ú‡ Ì‡ Í‡-‚ÂÌÓÏËÚÂ ÒÂ ÓˆÂÌfl‚‡ ÏÂÊ‰Û 0.4 Ë 0.9% ÓÚ ÔÓÔÛÎ‡ˆËflÚ‡,Ë 8-15% ÓÚ ‚ÒË˜ÍË Ò˙‰Ó‚Ë Ï‡ÎÙÓÏ‡ˆËË (6, 11, 12), ÌÓ ÌÂ‚ÒË˜ÍË ÎÂÁËË Ò‡ ÒËÏÔÚÓÏ‡ÚË˜ÌË. ÖÔËÎÂÔÒËflÚ‡ Â Ì‡È-˜ÂÒ-Ú‡Ú‡ ÍÎËÌË˜Ì‡ ÔÓfl‚‡ Ì‡ ·ÓÎÌËÚÂ Ò ÏÓÁ˙˜ÌË Í‡‚ÂÌÓÏËË ‚ ‰ÓÒÚ‡ ‚ËÒÓÍ ÔÓˆÂÌÚ Úfl ÓÒÚ‡‚‡ ÏÂ‰ËÍ‡ÏÂÌÚÓÁÌÓ Â-ÁËÒÚÂÌÚÌ‡. ë ‡Á‚ËÚËÂÚÓ Ì‡ ‰Ë‡„ÌÓÒÚË˜ÌËÚÂ ÒÂ‰ÒÚ‚‡Ë Ì‡È-‚Â˜Â Ï‡„ÌËÚÌÓÂÁÓÌ‡ÌÒÌ‡Ú‡ ÚÓÏÓ„‡ÙËfl ‚ÒÂ ÔÓ‚Â-˜Â Ì‡‡ÒÚ‚‡ ·ÓflÚ Ì‡ ‰Ë‡„ÌÓÒÚËˆË‡ÌËÚÂ Ë ÓÔÂË‡ÌË·ÓÎÌË Ò Ú‡ÍË‚‡ ÎÂÁËË. àÁ·Ó˙Ú Ì‡ Ì‡È-ÔÓ‰ıÓ‰fl˘Ó ÎÂ˜ÂÌËÂÔË ÚÂÁË Ô‡ˆËÂÌÚË ÒÂ ÓÒÌÓ‚‡‚‡ Ì‡ ‚ÌËÏ‡ÚÂÎÂÌ ‡Ì‡ÎËÁ Ì‡ÔÂ‰ËÏÒÚ‚‡Ú‡, Í‡ÍÚÓ Ë ËÒÍÓ‚ÂÚÂ ÓÚ ÓÔÂ‡ÚË‚ÌÓÚÓ ËÏÂ‰ËÍ‡ÏÂÌÚÓÁÌÓ ÎÂ˜ÂÌËÂ Ë ÂÁÛÎÚ‡ÚËÚÂ ÓÚ Úflı.

åÄíÖêàÄã à åÖíéÑà

160 Ô‡ˆËÂÌÚË Ò‡ ÓÔÂË‡ÌË ‚ ÍÎËÌËÍ‡Ú‡ Á‡ ÏÓÁ˙˜ÌË Í‡-‚ÂÌÓÏË Á‡ 22 „Ó‰Ë¯ÂÌ ÔÂËÓ‰ (1986-2007).

éÚ Úflı 121 Ò‡ ËÏ‡ÎË ÒÛÔ‡ÚÂÌÚÓË‡ÎÌË Ë 39 ËÌÙ‡-ÚÂÌÚÓË‡ÎÌË ÎÂÁËË.

ëÂ‰Ì‡Ú‡ ‚˙Á‡ÒÚ Â 36 „Ó‰ËÌË (ÓÚ 1 ‰Ó 70 „.), ë˙ÓÚ-ÌÓ¯ÂÌËÂÚÓ Ï˙ÊÂ/ÊÂÌË Â 78/82.

ÖÔËÎÂÔÚË˜ÌË ÔÓfl‚Ë Ò‡ ËÏ‡ÎË 82 ‰Û¯Ë – 51.3% ÓÚ‚ÒË˜ÍË ·ÓÎÌË Ë 67.8% ÓÚ ÒÛÔ‡ÚÂÌÚÓË‡ÎÌËÚÂ.

Ñ˙Î„ÓÒÓ˜ÌÓ ÔÓÛ˜‚‡ÌÂ Â ÔÓ‚Â‰ÂÌÓ Á‡ ÒÓÍ ÓÚ 6 ‰Ó226 ÏÂÒ. (Ò. 67 ÏÂÒ.).

êÖáìãíÄíà

ÑÓ·Ó ÔÓ‚ÎËfl‚‡ÌÂ Ì‡ ÔËÔ‡‰˙ˆËÚÂ (ÔÂÍ‡Úfl‚‡ÌÂ ËÎËÌ‡Ï‡Îfl‚‡ÌÂ ÔÓ ˜ÂÒÚÓÚ‡ Ë ÚÂÊÂÒÚ) ÒÂ ÓÚ˜ËÚ‡ ÔË 89%ÓÚ Ô‡ˆËÂÌÚËÚÂ.

ëÏ˙ÚÌÓÒÚÚ‡ ‚˙ÁÎËÁ‡ Ì‡ 2.4% (2 ÒÎÛ˜‡fl) Á‡ ÚÂÁË ÒÂÔËÎÂÔÒËfl Ë ÔÂËÓÔÂ‡ÚË‚ÂÌ ÏÓ·Ë‰ËÚÂÚ 9.9%. Ñ˙Î„ÓÒ-Ó˜ÌÓÚÓ ÔÓÒÎÂ‰fl‚‡ÌÂ ÔÓÍ‡Á‚‡ ÔÓÒÚÂÔÂÌÌÓ ÔÓ‰Ó·ÂÌËÂÌ‡ ‰ÂÙËˆËÚ‡ ÔË ÔÓ‚Â˜ÂÚÓ ÒÎÛ˜‡Ë Ë Ú‡ÈÌËflÚ ÏÓ·Ë‰Ë-ÚÂÚ ‚˙ÁÎËÁ‡ Ì‡ 3.3%.

ëÂ‰ÌËflÚ ÂÁÛÎÚ‡Ú ÔÓ ÒÍ‡Î‡Ú‡ Ì‡ Karnofsky Á‡ „ÛÔ‡Ú‡·ÓÎÌË Ò ÂÔËÎÂÔÒËfl Â 90.

éÅëöÜÑÄçÖ

èË ÒÂ‰Ì‡ ˜ÂÒÚÓÚ‡ ÓÚ ÎËÚÂ‡ÚÛÌËÚÂ ‰‡ÌÌË 0.4%ÓÚ Ì‡ÒÂÎÂÌËÂÚÓ (6, 11, 12), ‚ Å˙Î„‡Ëfl ÏÓÊÂ ‰‡ ÒÂ Ó˜‡Í‚‡Ò˙˘ÂÒÚ‚Û‚‡ÌÂ Ì‡ ÓÍ. 30 000 ‰Û¯Ë Ò Í‡‚ÂÌÓÏË Ì‡ „Î‡‚ÌËflÏÓÁ˙Í. ëËÏÔÚÓÏ‡ÚË˜ÌÓ Í˙‚ÂÌÂ ÔË ÚÂÁË ÎÂÁËË ÓÚ 0.7%‰Ó 2.63% „Ó‰Ë¯ÌÓ8, 13, ÓÁÌ‡˜‡‚‡ ÔÓÌÂ 200 ‰Û¯Ë Ì‡ „Ó‰ËÌ‡Ò ÍÎËÌË˜ÌÓ ËÁfl‚ÂÌ‡ ÒËÏÔÚÓÏ‡ÚËÍ‡, ÔË˜ËÌÂÌ‡ ÓÚ äëå.åÂÊ‰Û 35% Ë 70% ÓÚ ÒËÏÔÚÓÏ‡ÚË˜ÌËÚÂ Í‡‚ÂÌÓÏË Ò‡‡ÒÓˆËË‡ÌË Ò ÔÓ‚Ú‡fl˘Ë ÒÂ ÔËÔ‡‰˙ˆË, ÍÓËÚÓ Ò‡ ÏÂ‰ËÍ‡-ÏÂÌÚÓÁÌÓ ÂÁËÒÚÂÌÚÌË ‚ 40% ÓÚ ÒÎÛ˜‡ËÚÂ (14) Ë ÓÍÓÎÓ4% ÓÚ ÂÁËÒÚÂÌÚÌËÚÂ Ô‡ˆË‡ÎÌË ÂÔËÎÂÔÒËË ÒÂ ‰˙ÎÊ‡Ú Ì‡äëå. ëÔÓÂ‰ ÌflÍÓË ‡‚ÚÓË 41-59% ÓÚ ÒËÏÔÚÓÏ‡ÚË˜ÌË-ÚÂ Í‡‚ÂÌÓÏË ÒÂ ÔÂ‰ÒÚ‡‚flÚ Ò ÔËÔ‡‰˙ˆË (5). ÑÛ„Ë Ò‡‚-Ìfl‚‡Ú ÂÔËÎÂÔÚË˜ÌËÚÂ ÔÓfl‚Ë ÔË Ô‡ˆËÂÌÚË Ò Í‡‚ÂÌÓÏËÒ ÚÂÁË Ò ‡ÚÂËÓ‚ÂÌÓÁÌË Ï‡ÎÙÓÏ‡ˆËË Ë „ÎËÓÏË Ë Ì‡ÏË-‡Ú 50-70% ÔË Í‡‚ÂÌÓÏË, 20-40% ÔË ÄÇå Ë 10-30% ÔË„ÎËÓÏËÚÂ (2). è‡Í ÒÔÓÂ‰ Úflı äëå ‡ÁÔÓÎÓÊÂÌË ‚ ÚÂÏÔÓ-‡ÎÌËfl ‰flÎ Ò‡ Ò ÔÓ-‚ËÒÓÍ‡ ˜ÂÒÚÓÚ‡ Ì‡ ÔËÔ‡‰˙ˆËÚÂ Ë Ì‡È-˜ÂÒÚÓ ÏÂ‰ËÍ‡ÏÂÌÚÓÁÌÓ ÂÙ‡ÍÚÂÌË. èÓ-fl‰Í‡ ËÁ„ÎÂÊ‰‡ÂÔËÎÂÔÒËflÚ‡ ÔË ˜ÂÎÌÓ ‡ÁÔÓÎÓÊÂÌËÂ (10). Ç Â‰Ì‡ ÁÌ‡˜Ë-ÚÂÎÌ‡ ÒÂËfl Ô‡ˆËÂÌÚË (11) Ó·˘ËflÚ ÔÓÒÔÂÍÚË‚ÂÌ ËÒÍÓÚ ÂÔËÎÂÔÒËfl Â ËÁ˜ËÒÎÂÌ Ì‡ 4.8% Ì‡ Ô‡ˆËÂÌÚ/„Ó‰ËÌ‡, ‰ÓÍ‡-ÚÓ ÌÓ‚ÓÔÓfl‚ËÎË ÒÂ Ò‡ Ì‡ÏÂÂÌË 2.4% Ì‡ Ô‡ˆËÂÌÚ/„Ó‰ËÌ‡.

ÇÒË˜ÍË ÚÂÁË ‰‡ÌÌË ÒÓ˜‡Ú ÍÎËÌË˜Ì‡Ú‡ ÁÌ‡˜ËÏÓÒÚ Ì‡ÚÓÁË ‚Ë‰ Ô‡ÚÓÎÓ„Ëfl. Ç Ì‡¯‡Ú‡ ÒÂËfl ‰‡‚ÌÓÒÚÚ‡ ÓÚ Ô˙-‚ËflÚ ÂÔËÎÂÔÚË˜ÂÌ ÔËÔ‡‰˙Í ‰Ó ‰Ë‡„ÌÓÒÚËˆË‡ÌÂÚÓ Ì‡ÏÓÁ˙˜ÂÌ Í‡‚ÂÌÓÏ Â ÒÂ‰ÌÓ 42.5 ÏÂÒÂˆ‡. ä‡ÍÚÓ Â ËÁ‚ÂÒÚ-ÌÓ ÓÚ Ì‡ÎË˜ÌËÚÂ ÔÛ·ÎËÍ‡ˆËË, ÔÓ-‰˙Î„ËflÚ ÔÂËÓ‰ Ò ÔÂ‰Ó-ÔÂ‡ÚË‚Ì‡ ÂÔËÎÂÔÒËfl ÍÓÂÎË‡ Ò ÔÓ-ÒÎ‡·Ó ÒÎÂ‰ÓÔÂ‡ÚË‚-ÌÓ ÔÓ‚ÎËfl‚‡ÌÂ (10). éÚ ‰Û„‡ ÒÚ‡Ì‡ ÏÓÊÂ ‰‡ ÒÂ ÒÔÂÍÛÎË-‡ ÓÍÓÎÓ ‚˙ÔÓÒ‡ ÍÓÂÍÚÌÓ ÎË Â ‰‡ ÒÂ Ì‡Â˜Â ÂÔËÎÂÔÒËflÂ‰ËÌ Â‰ËÌÒÚ‚ÂÌ ÔËÔ‡‰˙Í? ëÎÂ‰‚‡˘ËflÚ ‚˙ÔÓÒ Â ‰‡ÎË ÂÁ‡‰˙ÎÊËÚÂÎÌÓ Ò˙‚Ô‡‰ÂÌËÂ Ì‡ Ó·‡ÁÌËÚÂ Ë ÂÎÂÍÚÓÙËÁËÓ-ÎÓ„Ë˜ÌË ‰‡ÌÌË, Á‡ ‰‡ ÒÂ ‚ÁÂÏÂ Â¯ÂÌËÂ Á‡ ËÌÚÂ‚ÂÌˆËfl?çflÏ‡ Ó·˘ÓÔËÂÚÓ ÏÌÂÌËÂ ÔÓ ÚÂÁË ‚˙ÔÓÒË. ÑÓ·Â ËÁ‚Â-ÒÚÌÓ Â, ˜Â Ò˙˘ÂÒÚ‚Û‚‡Ú ·ÓÎÌË Ò ÍÎËÌË˜ÌÓ ÔÓfl‚ÂÌ‡ ÂÔË-ÎÂÔÒËfl, ÔË ÌÓÏ‡ÎÌ‡ ÖÖÉ Ì‡ıÓ‰Í‡. á‡ÚÓ‚‡ ÒÏflÚ‡ÏÂ, ˜ÂÌ‡ÎË˜ËÂÚÓ Ì‡ ÍÎËÌË˜Ì‡ ÒËÏÔÚÓÏ‡ÚËÍ‡ Ë Ó·‡ÁÌÓ ‰ÓÍ‡Á‡-Ì‡ ÏÓÙÓÎÓ„Ë˜Ì‡ ÎÂÁËfl Ò‡ ‰ÓÒÚ‡Ú˙˜ÌÓ ÓÒÌÓ‚‡ÌËÂ Á‡ ÓÔÂ-‡ÚË‚Ì‡ ÂÍÒˆËÁËfl, ‰ÓË ‰‡ ÌflÏ‡ Ô˙ÎÌÓ Ò˙‚Ô‡‰ÂÌËÂ Ì‡ ‰‡Ì-ÌËÚÂ ÓÚ ËÌÒÚÛÏÂÌÚ‡ÎÌËÚÂ ËÁÒÎÂ‰‚‡ÌËfl. áÌ‡˜ËÚÂÎÌÓÔÓ-ÚÛ‰Ì‡ ÒÚ‡‚‡ Á‡‰‡˜‡Ú‡ ÔË ÏÛÎÚËÔÎÂÌËÚÂ äëå. íÓ-„‡‚‡ Á‡‰˙ÎÊËÚÂÎÌÓ Ú˙ÒËÏ Ò˙ÓÚ‚ÂÚÒÚ‚ËÂ Ì‡ ÒËÏÔÚÓ-Ï‡ÚËÍ‡Ú‡ Ë ÖÖÉ ‰‡ÌÌËÚÂ Ò ÌflÍÓfl ÓÚ Ó·‡ÁÌËÚÂ Ì‡ıÓ‰-ÍË. ç‡ËÒÚËÌ‡ Ò˙˘ÂÒÚ‚Û‚‡ ÁÌ‡˜ËÚÂÎÌ‡ ‚ÂÓflÚÌÓÒÚ ÔËÚÂÁË Ô‡ˆËÂÌÚË ‰Û„‡ ÓÚ Í‡‚ÂÌÓÁÌËÚÂ Ï‡ÎÙÓÏ‡ˆËË ‰‡ÔÂ‰ËÁ‚ËÍ‡ ÂÔËÎÂÔÒËfl ‚ÔÓÒÎÂ‰ÒÚ‚ËÂ, ÌÓ ÓÚÒÚ‡Ìfl‚‡ÌÂ-ÚÓ Ì‡ ‰ÓÏËÌË‡˘‡Ú‡ ÓÚ Úflı ÔÓÁ‚ÓÎfl‚‡ ÍÓÌÚÓÎ Ì‡‰ÔËÔ‡‰˙ˆËÚÂ Á‡ ‰˙Î„Ó ‚ÂÏÂ.

äÓ„‡ÚÓ Ó·Ò˙Ê‰‡ÏÂ ıËÛ„Ë˜ÌÓÚÓ ÎÂ˜ÂÌËÂ Ì‡ ÂÔËÎÂÔ-ÒËflÚ‡, ÔË˜ËÌÂÌ‡ ÓÚ Í‡‚ÂÌÓÏË, ÌÂ ÏÓÊÂÏ ‰‡ ÌÂ ÒÂ ÒÔÂÏÌ‡ ‚˙ÔÓÒ‡ Á‡ Ó·ÂÏ‡ Ì‡ ÂÍÒˆËÁËflÚ‡. ÅÂÁÒÔÓÂÌ Â ËÁ‚Ó‰‡ Ì‡‚ÒË˜ÍË ‡‚ÚÓË Á‡ ÔÓÎÁ‡Ú‡ ÓÚ ÎÂÁËÓÌÂÍÚÓÏËfl (2, 3). ÇÒÂ-Ó·˘Ó Â Ë ÏÌÂÌËÂÚÓ, ˜Â ÓÍÓÎÌ‡Ú‡ Ú˙Í‡Ì, Ì‡ÚÓ‚‡ÂÌ‡ Ò ıÂ-ÏÓÒË‰ÂËÌ Ë Â‡ÍÚË‚Ì‡ „ÎËÓÁ‡ Ò˙˘Ó Úfl·‚‡ ‰‡ ÒÂ ÂÍÒˆË-ÁË‡ (4, 15). Ä„ÛÏÂÌÚ Á‡ ÚÓ‚‡ Â ÓÎflÚ‡ Ì‡ ıÂÏÓ„ÎÓ·ËÌ‰Â„‡‰‡ˆËÓÌÌËÚÂ ÔÓ‰ÛÍÚË Á‡ ÔÓ‚Ë¯‡‚‡ÌÂ Ì‡ ÂÔËÎÂÔÚÓ-


í‡·ÎËˆ‡ 1: äÎËÌË˜ÌË ÔÓfl‚Ë Ì‡ ·ÓÎÌËÚÂ Ò˙Ò ÒÛÔ‡ÚÂÌÚÓË‡ÎÌË äëå

„Î‡‚Ó- ıËÔÂ- ÂÔËÎÂÔÒËfl Ó„ÌË˘ÂÌ ëÄä Ô‡ÂÌıËÏÌË·ÓÎËÂ ÚÂÌÒËfl ‰ÂÙËˆËÚ ıÂÏ‡ÚÓÏË

ÅÓÈ 21 13 82 42 5 16%ÓÚÒÛÔ- 17.4% 10.9% 67.8% 34.8% 4.3% 13.2%‡ÚÂÌÚ.% ÓÚ 13.1% 8.1% 51.3% 26.3% 3.1% 10%‚ÒË˜ÍË äëåá‡·ÂÎÂÊÍ‡: Ò·Ó˙Ú Â Ì‡‰ 100%, Ú˙È Í‡ÚÓ ˜‡ÒÚ ÓÚ ·ÓÎÌËÚÂ Ò‡ ËÏ‡ÎË ÔÓ‚Â˜ÂÓÚ Â‰ËÌ ÍÎËÌË˜ÂÌ ÔËÁÌ‡Í.

í‡·ÎËˆ‡ 2: ê‡ÌÌË Ë Í˙ÒÌË ÒÎÂ‰ÓÔÂ‡ÚË‚ÌË ÂÁÛÎÚ‡ÚË

èÓ‚ÎËfl‚‡ÌÂ Ì‡ èÂËÓÔÂ‡ÚË‚ÂÌ í‡ÂÌ Karnofsky ÔËÔ‡‰˙ˆËÚÂ ÏÓ·Ë‰ËÚÂÚ ÏÓ·Ë‰ËÚÂÚ (Ò. 67 ÏÂÒ.)89% 9.9% 3.3% 90

„ÂÌÌ‡Ú‡ ‡ÍÚË‚ÌÓÒÚ (14), ‰ÓÍ‡Á‡Ì‡ ÂÍÒÔÂËÏÂÌÚ‡ÎÌÓ Ì‡ÔÎ˙ıÓ‚Â. èÓÍ‡Á‡ÌËflÚ Ì‡ ÙË„. 1 ÒÎÛ˜‡È ËÎ˛ÒÚË‡ ÌÂÓ·ıÓ-‰ËÏÓÒÚÚ‡ ÓÚ ÔÓ-¯ËÓÍ‡ ÂÁÂÍˆËfl, ÓÒÓ·ÂÌÓ ÔË ÚÂÏÔÓ-‡ÎÌËÚÂ äëå. êÂÓÔÂ‡ˆËflÚ‡ ÏÓÊÂ Ò˙˘Ó ‰‡ ‰Ó‚Â‰Â ‰Ó‰Ó·˙ ÍÓÌÚÓÎ Ì‡ ÂÔËÎÂÔÒËflÚ‡. Ö‰ËÌ ÁÌ‡˜ËÏ Ù‡ÍÚÓ Ó·‡-˜Â Á‡ ÌÂÔÓ‚ÎËfl‚‡ÌÂ Ì‡ ÔËÔ‡‰˙ˆËÚÂ ÒÎÂ‰ ÓÔÂ‡ÚË‚Ì‡Ú‡ËÌÚÂ‚ÂÌˆËfl Â ÙÓÏË‡ÌÂÚÓ Ì‡ ‚ÚÓË˜ÌË ÂÔËÎÂÔÚÓ„ÂÌ-ÌË Ó„ÌË˘‡. íÓ„‡‚‡ ÎÂÁËÓÌÂÍÚÓÏËflÚ‡, ‰ÓË ÔË ¯ËÓÍÓÔÂÏ‡ı‚‡ÌÂ Ì‡ Ò˙ÒÂ‰ÌËÚÂ ÔÓÏÂÌÂÌË Ú˙Í‡ÌË ÏÓÊÂ ‰‡ ·˙-‰Â ÌÂ‰ÓÒÚ‡Ú˙˜Ì‡. ç‡ÔÓÒÎÂ‰˙Í Ò˙˘ÂÒÚ‚Û‚‡Ú Ë ‰ÓÍ‡Á‡ÚÂ-ÎÒÚ‚‡ Á‡ ÍÓÏ·ËÌË‡Ì‡ Ô‡ÚÓÎÓ„Ëfl - äëå Ò ıËÔÓÍ‡ÏÔ‡ÎÌ‡ÒÍÎÂÓÁ‡, ÍÓÚËÍ‡ÎÌ‡ ‰ËÒÔÎ‡ÁËfl ËÎË ÌËÒÍÓÒÚÂÔÂÌÌË „ÎËÓ-ÏË ‚ ·ÎËÁÓ ÔÓÎÓ‚ËÌ‡Ú‡ ÓÚ ÒÎÛ˜‡ËÚÂ, ÍÓ„‡ÚÓ ÎÓÍ‡ÎËÁ‡ˆË-flÚ‡ Â ÚÂÏÔÓ‡ÎÌ‡ (7). íÂ Ò˙˘Ó ‰ÓÔËÌ‡ÒflÚ Á‡ ÌÂÁ‡‰Ó‚Ó-ÎËÚÂÎÌÓÚÓ ÒÎÂ‰ÓÔÂ‡ÚË‚ÌÓ ÔÓ‚ÎËfl‚‡ÌÂ, ‡ÍÓ ÌÂ ÒÂ ÔÂ‰Ô-ËÂÏÂ ¯ËÓÍ‡ ÚÂÏÔÓ‡ÎÌ‡ ÂÁÂÍˆËfl.

é˘Â Â‰ËÌ ‚‡ÊÂÌ ‚˙ÔÓÒ Â ÌÂÓ·ıÓ‰ËÏÓÒÚÚ‡ ÓÚ ÓÔÂ‡-

ÚË‚Ì‡ ÂÍÒˆËÁËfl, ÍÓ„‡ÚÓ ËÏ‡ ‰Ó·˙ ÏÂ‰ËÍ‡ÏÂÌÚÓÁÂÌÍÓÌÚÓÎ Ì‡ ÂÔËÎÂÔÒËflÚ‡. ë˙˘ÂÒÚ‚ÂÌ ‡„ÛÏÂÌÚ ‚ ÔÓÎÁ‡Ì‡ ıËÛ„Ë˜Ì‡Ú‡ ‡ÍÚË‚ÌÓÒÚ Â ÔÂ‰Ô‡Á‚‡ÌÂ Ì‡ Ô‡ˆËÂÌÚ‡ÓÚ ıÂÏÓ‡„ËË, ÍÓËÚÓ ·Ëı‡ ÏÓ„ÎË ‰‡ ÔÂ‰ËÁ‚ËÍ‡Ú ÁÌ‡˜Ë-ÚÂÎÂÌ ÌÂ‚ÓÎÓ„Ë˜ÂÌ ‰ÂÙËˆËÚ (3).

çÂ ·Ë‚‡ ‰‡ ÒÂ ÔÓÔÛÒÍ‡ Ë ‚ÂÓflÚÌÓÒÚÚ‡ Á‡ ‰Â ÌÓ‚Ó Ó·-‡ÁÛ‚‡ÌÂ ËÎË ÂˆË‰Ë‚ Ì‡ äëå ÒÎÂ‰ ÚflıÌ‡Ú‡ ÂÍÒˆËÁËfl.ÇÒÂ ÔÓ‚Â˜Â ‰ÓÍ‡Á‡ÚÂÎÒÚ‚‡ Ò‡ Ì‡ÚÛÔ‡ÌË ‚ ÔÓÒÎÂ‰ÌÓ ‚Â-ÏÂ Á‡ Ú‡ÍË‚‡ ÔÓˆÂÒË (7), ÍÓÂÚÓ Ì‡Î‡„‡ Á‡‰˙ÎÊËÚÂÎÂÌåêí ÍÓÌÚÓÎ Ì‡ ÓÔÂË‡ÌËÚÂ ·ÓÎÌË ‰ÓË Ë ÔË ÓÚÒ˙-ÒÚ‚ËÂ Ì‡ ÒËÏÔÚÓÏ‡ÚËÍ‡.

äÓ„‡ÚÓ ‡Á„ÎÂÊ‰‡ÏÂ ÂÁÛÎÚ‡ÚËÚÂ ÓÚ ÓÔÂ‡ÚË‚ÌÓÚÓÎÂ˜ÂÌËÂ ‚ Ì‡¯‡Ú‡ ÒÂËfl Úfl·‚‡ ‰‡ ÓÚ·ÂÎÂÊËÏ ÔËÂÏÎË-‚Ó ÌËÒÍËflÚ ÏÓ·Ë‰ËÚÂÚ Ë ‚ËÒÓÍ‡Ú‡ ÒÚÂÔÂÌ Ì‡ ÍÓÌÚÓÎÌ‡ ÂÔËÎÂÔÒËflÚ‡. èÂ‰Ë¯ÌÓ ÔÓÛ˜‚‡ÌÂ Ì‡ ÚÂÁË ÂÁÛÎÚ‡ÚË‚ ÒÚ‡Ì‡Ú‡ ÔÓÍ‡Á‚‡ ÒıÓ‰ÌË ‰‡ÌÌË (1). èÓ‰Ó·ÌË Ò‡ Ë ÂÁÛÎ-Ú‡ÚËÚÂ ÓÚ ÔÓ‚Â˜ÂÚÓ ÁÌ‡˜ËÚÂÎÌË ÒÂËË ‚ ÎËÚÂ‡ÚÛ‡-Ú‡ (10). èËÎ‡„‡ÌÂÚÓ Ì‡ ‚ËÒÓÍÓÚÂıÌÓÎÓ„Ë˜ÌËÚÂ ÏÂÚÓ‰ËÍ‡ÚÓ ÌÂ‚ÓÌ‡‚Ë„‡ˆËfl, ‡ÏÍÓ‚‡ ÒÚÂÂÓÚ‡ÍÒËfl Ë ÌÂ‚ÓÂÌ-‰ÓÒÍÓÔËfl Ô‡‚flÚ ıËÛ„Ë˜Ì‡Ú‡ Ì‡ÏÂÒ‡ Ó˘Â ÔÓ-ÒË„ÛÌ‡(ÙË„. 2). é˘Â Â‰ËÌ ‚‡ÊÂÌ ‡„ÛÏÂÌÚ Â Ò˙ı‡ÌÂÌ‡Ú‡ ÙÛÌÍ-ˆËÓÌ‡ÎÌ‡ ‡ÍÚË‚ÌÓÒÚ Ì‡ Ô‡ˆËÂÌÚËÚÂ Ò˙Ò ÒÂ‰ÂÌ ÂÁÛÎ-Ú‡Ú ÔÓ Karnofsky 90, Í‡ÍÚÓ ÔÓÍ‡Á‚‡ ‰˙Î„ÓÒÓ˜ÌÓÚÓÔÓÒÎÂ‰fl‚‡ÌÂ.


óÂÒÚÓÚ‡Ú‡ Ì‡ ÏÓÁ˙˜ÌËÚÂ Í‡‚ÂÌÓÏË Ò Ó˜‡Í‚‡Ì‡ ÍÎË-ÌË˜Ì‡ ËÁfl‚‡ Â 2.8/100 000 Ì‡ÒÂÎÂÌËÂ Ë Á‡Òfl„‡ „Î‡‚ÌÓ ıÓ‡ ‚‡ÍÚË‚Ì‡ ‚˙Á‡ÒÚ (3ÚÓ – 5ÚÓ ‰ÂÒÂÚËÎÂÚËÂ), ÍÓÂÚÓ „Ó Ô‡-‚Ë Á‡·ÓÎfl‚‡ÌÂ Ò ‚ËÒÓÍ‡ ÒÓˆË‡ÎÌ‡ ÁÌ‡˜ËÏÓÒÚ. ÉÓÎflÏ‡ ˜‡ÒÚ(40%) ÓÚ ÔËÒÚ˙ÔËÚÂ ÔË ·ÓÎÌË Ò äëå Ò‡ ÏÂ‰ËÍ‡ÏÂÌ-ÚÓÁÌÓ ÂÙ‡ÍÚÂÌË Ë ËÁ‚˙¯‚‡ÌÂÚÓ Ì‡ åêí Úfl·‚‡ ‰‡·˙‰Â Á‡‰˙ÎÊËÚÂÎÌ‡ ˜‡ÒÚ ÓÚ ËÁÒÎÂ‰‚‡ÌÂÚÓ Ì‡ ·ÓÎÌËÚÂ ÒÂÔËÎÂÔÒËfl. ê‡ÁÎË˜ÌË ‰Û„Ë ÏÓÁ˙˜ÌË ÎÂÁËË ÏÓ„‡Ú ‰‡ Ì‡ÔÓ-‰Ó·fl‚‡Ú Ó·‡Á‡ Ì‡ äëå, ËÎË Ò‡ÏËÚÂ Í‡‚ÂÌÓÏË ‰‡ ·˙‰‡ÚÔÂˆÂÌÂÌË ÔÂ‰‚‡ËÚÂÎÌÓ Í‡ÚÓ ‰Û„Ó Á‡·ÓÎfl‚‡ÌÂ, ÔÓ‡‰ËÍÓÂÚÓ Â‰ËÌÒÚ‚ÂÌÓ ıËÒÚÓÎÓ„Ë˜Ì‡Ú‡ ‚ÂËÙËÍ‡ˆËfl ÒÂ ÔË-


îË„.2: è‡ˆËÂÌÚ Ì‡ 35 „. Ò 5 ÔËÔ‡‰˙Í‡ (grand mal) Á‡ 1 „Ó‰ËÌ‡ ‚˙ÔÂÍË‡ÌÚËÍÓÌ‚ÛÎÒË‚Ì‡Ú‡ ÚÂ‡ÔËfl. Ä – ‚‰flÒÌÓ ˜ÂÎÌÓ ÔÂÏÓÚÓÌÓ ÎË˜Ë ÎÂÁËfl ÒÚËÔË˜ÂÌ ‚Ë‰ Ì‡ Í‡‚ÂÌÓÏ Ò ıÂÏÓÒË‰ÂËÌÂÌ Ô˙ÒÚÂÌ ÔÓ ÔÂËÙÂËflÚ‡. Ç –

ÒÎÂ‰ ÌÂ‚ÓÌ‡‚Ë„Ë‡Ì‡ ÂÍÒˆËÁËfl ÒÂ ËÁÓ·‡Áfl‚‡ Ò‡ÏÓ ÔÓÒÚÓÔÂ‡ÚË‚ÂÌ‰ÂÙÂÍÚ. ÅÓÎÌËflÚ Â ·ÂÁ ÔËÔ‡‰˙ˆË Ë ·ÂÁ ÚÂ‡ÔËfl 1 „. ÒÎÂ‰

ËÌÚÂ‚ÂÌˆËflÚ‡.

îË„. 1: A - ÅÓÎÌ‡ Ì‡ 32 „. Ò ÏÂ‰ËÍ‡ÏÂÌÚÓÁÌÓ ÂÁËÒÚÂÌÚÌ‡ ÂÔËÎÂÔÒËfl Ë ÂÊÂ‰ÌÂ‚ÌË „ÓÎÂÏË ÔËÔ‡‰˙ˆË. éÚ åêí ÎË˜Ë Í‡‚ÂÌÓÏ Ò Ï‡ÎÍ‡ ıÂÏÓ‡„Ëfl ‚Îfl‚ÓÚÂÏÔÓ‡ÎÌÓ. Ç Ë ë – ÒÎÂ‰ÓÔÂ‡ÚË‚ÂÌ ÍÓÌÚÓÎ, ÔÓÍ‡Á‚‡˘ ˆflÎÓÒÚÌ‡ ÎÂÁËÓÌÂÍÚÓÏËfl. èÓ‡‰Ë Í‡ÚÍ‡Ú‡ ÂÏËÒËfl Á‡ 8 ÏÂÒÂˆ‡ Ò ‚˙ÁÓ·ÌÓ‚fl‚‡ÌÂ Ì‡

ÂÊÂ‰ÌÂ‚ÌËÚÂ ÔËÒÚ˙ÔË Â ÂÓÔÂË‡Ì‡ Ë Â ‡ÒÔËË‡Ì‡ ÍÓ‡Ú‡ ‚ Ò˙ÒÂ‰ÒÚ‚Ó ‚ ‰ÓÔÛÒÚËÏË „‡ÌËˆË, ÒÎÂ‰ ÍÓÂÚÓ Â ·ÂÁ ÌÓ‚Ë ÔËÒÚ˙ÔË.

ÂÏ‡ Á‡ ÒË„ÛÌ‡ ‰Ë‡„ÌÓÁ‡. äëå ÏÓ„‡Ú ‰‡ ·˙‰‡Ú ‰ÓÒÚË„Ì‡ÚË Ë ‡Ú‡ÍÛ‚‡ÌË Ò ‚ËÒÓ-

Í‡ ÒÚÂÔÂÌ Ì‡ ‡‰ËÍ‡ÎËÁ˙Ï ‰ÓË Ë ÔË ‡ÁÔÓÎÓÊÂÌËÂ ‚ ‰˙Î-·ÓÍË Ë ÚÛ‰ÌÓ‰ÓÒÚ˙ÔÌË Û˜‡ÒÚ˙ˆË Ì‡ ÏÓÁ˙Í‡. íÂıÌË˜ÂÒÍË-ÚÂ ÌÓ‚Ó‚˙‚Â‰ÂÌËfl, ‚ ÎËˆÂÚÓ Ì‡ ‡ÏÍÓ‚‡Ú‡ ÒÚÂÂÓÚ‡ÍÒËfl,ÌÂ‚ÓÌ‡‚Ë„‡ˆËflÚ‡ Ë ÌÂ‚ÓÂÌ‰ÓÒÍÓÔËflÚ‡ ÔÓ‚Ë¯‡‚‡Ú ÒË-„ÛÌÓÒÚÚ‡ Ë ÚÓ˜ÌÓÒÚÚ‡ Ë Ô‡‚flÚ ‰ÓÒÚ˙ÔÌË Á‡ ıËÛ„Ëfl‰ÓË ÍËÚË˜ÌÓ ‡ÁÔÓÎÓÊÂÌË Ë ÒÏflÚ‡ÌË ‰ÓÒÍÓÓ Á‡ ÌÂ-‰ÓÒÚ˙ÔÌË ÎÂÁËË, ·ÂÁ ÚÓ‚‡ ‰‡ ‚Ó‰Ë ‰Ó ‚ÎÓ¯‡‚‡ÌÂ Ì‡ ÂÁÛÎ-Ú‡ÚËÚÂ. ë˙‚ÂÏÂÌÌËÚÂ ÚÂıÌÓÎÓ„ËË ÔÓÁ‚ÓÎfl‚‡Ú ÔÓ-‡Ú-‡‚Ï‡ÚË˜Ì‡ ‡·ÓÚ‡ Ë ÏËÌËÏËÁË‡ÌÂ Ì‡ ‰ÓÒÚ˙ÔËÚÂ. ÖÚÓÁ‡˘Ó Ó·‡ÁÌÓ ˙ÍÓ‚Ó‰ÂÌËÚÂ ÚÂıÌËÍË Úfl·‚‡ ‰‡ ·˙‰‡Ú ÌÂ-ÓÚÏÂÌÌ‡ ˜‡ÒÚ ÓÚ ÎÂ˜ÂÌËÂÚÓ Ì‡ ÚÓ‚‡ Á‡·ÓÎfl‚‡ÌÂ.

ïËÛ„Ë˜Ì‡Ú‡ ÂÍÒˆËÁËfl Ì‡ Í‡‚ÂÌÓÏËÚÂ Â Ò˙ÔÓ‚Ó‰Â-Ì‡ Ò ÔËÂÏÎË‚ ‡ÌÂÌ Ë Í˙ÒÂÌ ÏÓ·Ë‰ËÚÂÚ, Ò‡‚ÌËÏ Ò˙ÒÁÌ‡˜ËÏËÚÂ ÔÛ·ÎËÍ‡ˆËË ‚ ÎËÚÂ‡ÚÛ‡Ú‡. ç‡ÚÛÔ‡ÌËflÚÓÔËÚ Ë ÚÂıÌË˜ÂÒÍÓ Ó·ÓÛ‰‚‡ÌÂ Ò‡ ‚‡ÊÌË Ù‡ÍÚÓË Á‡ ‰Ó·-ËÚÂ ÂÁÛÎÚ‡ÚË, ÔÓ‡‰Ë ÍÓÂÚÓ Â ÛÏÂÒÚÌÓ ÍÓÌˆÂÌÚË‡-ÌÂÚÓ Ì‡ ÚÂÁË ËÌÚÂ‚ÂÌˆËË ‚ Ó„‡ÌË˜ÂÌ ·ÓÈ ‚ËÒÓÍÓÒÔÂ-ˆË‡ÎËÁË‡ÌË ˆÂÌÚÓ‚Â.

Ñ˙Î„ÓÒÓ˜ÌÓÚÓ ÔÓÒÎÂ‰fl‚‡ÌÂ Ì‡ ÓÔÂË‡ÌËÚÂ ·ÓÎÌË‰ÓÍ‡Á‚‡ ‰Ó·ÓÚÓ ËÏ ÙÛÌÍˆËÓÌ‡ÎÌÓ Ò˙ÒÚÓflÌËÂ: ÒÂ‰ÌÓ 90ÔÓ ÒÍ‡Î‡Ú‡ Ì‡ Karnofsky. ä‡ÚÓ ÒÂ ‚ÁÂÏÂ ÔÂ‰‚Ë‰ ËÌ‚‡ÎË-‰ËÁË‡˘‡Ú‡ Ë ÔÓÌflÍÓ„‡ ÊË‚ÓÚÓÁ‡ÒÚ‡¯‡‚‡˘‡ ÒËÏÔÚÓ-Ï‡ÚËÍ‡ Ì‡ Ú‡ÁË Ô‡ÚÓÎÓ„Ëfl, Ì‡Ô˙ÎÌÓ ÓÔ‡‚‰‡ÌË Ò‡ ÛÒËÎË-flÚ‡ Á‡ ÔÓ‰Ó·fl‚‡ÌÂ Ì‡ ‰Ë‡„ÌÓÒÚËÍ‡Ú‡ Ë Û‚ÂÎË˜‡‚‡ÌÂ Ì‡ıËÛ„Ë˜Ì‡Ú‡ ‡ÍÚË‚ÌÓÒÚ.

ãàíÖêÄíìêÄ1. èÓÔÓ‚ êÇ. ïËÛ„Ë˜ÌÓ ÎÂ˜ÂÌËÂ Ì‡ Í‡‚ÂÌÓÏËÚÂ Ì‡ „Î‡‚ÌËfl ÏÓÁ˙Í (ÑË-

ÒÂÚ‡ˆËÓÌÂÌ ÚÛ‰ Á‡ ÔËÒ˙Ê‰‡ÌÂ Ì‡ Ó·‡ÁÓ‚‡ÚÂÎÌ‡ Ë Ì‡Û˜Ì‡ ÒÚÂÔÂÌ“ÑÓÍÚÓ”), ëÓÙËfl, (Å˙Î„.): åì – ëÓÙËfl 2005.

2. Awad IA, Robinson JR, Mohanty S, Esters ML: Mixed vascular malforma-

tions of the brain: Clinical and pathogenetic considerations. Neurosurgery,33, 1993, 179-188.

3. Awad I, Jabbour P, Cerebral cavernous malformations and epilepsy.Neurosurg Focus, 21, 2006, (1): E7.

4. Baumann ChR, Schuknecht B, Lo Russo G, Cossu M, Citterio A,Andermann F, Siegel AM. Seizure Outcome after Resection of CavernousMalformations Is Better When Surrounding Hemosiderin-stained Brain AlsoIs Removed. Epilepsia, 47, 2006 (3): 563–566.

5. Cohen DS, Zubay GP, Goodman RR. Seizure outcome after lesionectomy forcavernous malformations. J Neurosurg, 83, 1995, 237–242.

6. Del Curling OD Jr, Kelly DL Jr, Elster AD, Craven TE. An analysis of thenatural history of cavernous angiomas. J Neurosurg, 75, 1991, 702–708.

7. Eriksson SH, Nordborg C, Rydenhag B, Malmgren K. Parenchymal lesions inpharmacoresistant temporal lobe epilepsy: dual and multiple pathology. ActaNeurol Scand 112, 2005, 151–156.

8. Kondziolka D, Lunsford LD, Kestle JRW. The natural history of cerebral cav-ernous malformations. J Neurosurg 83, 1995, 820–824.

9. McCormick WF. Pathology of vascular malformations of the brain. In:Intracranial Arteriovenous Malformations (Wilson ChB, Stein BM eds.)Williams & Wilkins Baltimore, 1984, pp. 44-63.

10. Moran NF, Fish DR, Kitchen N, Shorvon S, Kendall BE, Stevens JM.Supratentorial cavernous haemangiomas and epilepsy: a review of the litera-ture and case series. J Neurol Neurosurg Psychiatry, 66, 1999, 561-568.

11. Moriarity JL, Wetzel M, Clatterbuck RE, Javedan SJ, Sheppard JM, Hoenig-Rigamonti K, Crone NE, Breiter SN, Lee RR, Rigamonti D. The natural his-tory of cavernous malformations: A prospective study of 68 patients.Neurosurgery 44, 1999, 1166–1173.

12. Porter RW, Detwiler PW, Spetzler RF, Lawton MT, Baskin JJ, Derksen PT,Zabramski JM. Cavernous malformations of the brainstem: experiences with100 patients. J Neurosurg, 90, 1999, 50–58.

13. Robinson JR, Awad IA, Little JR. Natural history of the cavernous angioma.J Neurosurg, 75, 1991, 709–714.

14. Ryvlin P, Mauguiere F, Sindou M, Froment JC, Cinotti L. Interictal cerebralmetabolism and epilepsy in cavernous angiomas. Brain 118, 1995, 677–687.

15. Williamson A, Patrylo PR, Lee S, Spencer DD. Physiology of human corticalneurons adjacent to cavernous malformations and tumors. Epilepsia, 44,2003, 1413–1419.

Ä‰ÂÒ Á‡ ÍÓÂÒÔÓÌ‰ÂÌˆËfl: Ñ- êÛÏÂÌ èÓÔÓ‚, äÎËÌËÍ‡ ÔÓ ÌÂ‚ÓıËÛ„Ëfl, ìåÅÄã “ë‚. à‚‡Ì êËÎÒÍË”åÂ‰ËˆËÌÒÍË ìÌË‚ÂÒËÚÂÚ - ëÓÙËfl, ÅÛÎ. “ÄÍ‡‰. à‚. ÉÂ¯Ó‚” ‹15, 1431, ëÓÙËfle-mail: [email protected]: 0898313439


éË„ËÌ‡ÎÌË ÒÚ‡ÚËËÑÇàÉÄíÖãçÄ àçÇÄãàÑàáÄñàü, äéÉçàíàÇçà

à ÖåéñàéçÄãçà çÄêìòÖçàü èêà Åéãçà ë èÄêäàçëéçéÇÄ ÅéãÖëí

Ñ.ïËÒÚÓ‚‡, á.á‡ı‡ËÂ‚, à.ÉÓÁ‰Â‚ä‡ÚÂ‰‡ ÔÓ ÌÂ‚ÓÎÓ„Ëfl Ë ÔÒËıË‡ÚËfl ÔË åì – èÎÓ‚‰Ë‚

äÎËÌËÍ‡ ÔÓ ÌÂ‚ÓÎÓ„Ëfl ÔË ìÌË‚ÂÒËÚÂÚÒÍ‡ ·ÓÎÌËˆ‡ ◊ë‚. ÉÂÓ„Ë” – èÎÓ‚‰Ë‚

SUMMARY

LOCOMOTORIAL INCAPACITATION, COGNITIVE ANDEMOTIONAL IMPAIRMENT IN PARKINSON’S DIS-

EASE PATIENTS.

D. Hristova, Z. Zahariev, I. GrozdevDepartment of Neurology and Psychiatry, Medical

University – Plovdiv, BulgariaClinic of Neurology – University Hospital, Plovdiv, Bulgaria

AIM: The purpose of the current study was to determine thedegree of locomotorial incapacitation, the degree of cognitiveand emotional impairment in Parkinson’s disease patients, andto evaluate the type and significance of the relations betweenthem.

PATIENTS AND METHODS: A total of 22 patients (485man and 437 women) with clinically determined Parkinson’sdisease (PD) by the London “Brain bank” Institute criteriawere evaluated. Their age varied between 46 to 96 years, mean73.76±0.25 years.

The degree of locomotorial incapacitation was determinedusing the Schwab-Endland scale. The expression of the cog-nitive and emotional impairment was evaluated with the use ofSection One - “Conduct, thinking and emotions” of theUPDRS scale. The correlation quotient R was determined,providing the strength and direction of the interconnectionsbetween the different parameters – locomotorial and cognitiveimpairment, locomotorial and emotional impairment and cog-nitive and emotional impairment.

RESULTS: From all studied patients with PD 78.21% weredependent to a different degree on other persons in theireveryday locomotorial activity. From those 27.64% wereheavily incapacitated - bound to a wheelchair or bed. A heav-ier degree of incapacitation in everyday activities was deter-mined in women than men with PD (χ2=16.207, p=0.063).

The cognitive decline including intellectual changes andthinking process impairment was found in 72.99% and65.08% of the patients respectively. Those with moderateintellectual change accounted for 8.79% of the patients whilethose with moderate degree of thinking impairment – 14.1%.

Emotional changes – depression was reported by 57.37%of the patients, while motivation was diminished in 53.36% ofall PD patients. Depression was moderate and severe in 20%while moderately expressed motivation decline was detectedin 25.06% of all patients.

We determined a moderate degree correlation between thelocomotorial and cognitive impairment (R=0.51, p<0.01),locomotorial and emotional impairment (R=0.50, p<0.01),cognitive and emotional impairment (R=0.55, p<0.01).

CONCLUSIONS: Our study quantified and confirmed thefact that PD leads to a significant degree of locomotorial andemotional incapacitation, which are interconnected and deter-mine the great socio-economic importance of this illness.

KEY WORDS: Parkinson’s disease, locomotorial incapac-itation, cognitive and emotional impairment, correlation quotient.

êÖáûåÖ

ñÖã: ñÂÎÚ‡ Ì‡ ÔÓÛ˜‚‡ÌÂÚÓ ·Â¯Â ‰‡ ÒÂ ÓÔÂ‰ÂÎË ÒÚÂ-ÔÂÌÚ‡ Ì‡ ‰‚Ë„‡ÚÂÎÌ‡Ú‡ ËÌ‚‡ÎË‰ËÁ‡ˆËfl, ÚÂÊÂÒÚÚ‡ Ì‡ÍÓ„ÌËÚË‚ÌËÚÂ, ÂÏÓˆËÓÌ‡ÎÌËÚÂ Ì‡Û¯ÂÌËfl Ë ‰‡ ÒÂ ÛÒÚ‡-ÌÓ‚Ë ı‡‡ÍÚÂ‡ Ë ÒËÎ‡Ú‡ Ì‡ ‚˙ÁÍ‡ ÏÂÊ‰Û Úflı ÔË ·ÓÎ-ÌËÚÂ Ò èÅ.

åÄíÖêàÄã à åÖíéÑà:Åflı‡ ËÁÒÎÂ‰‚‡ÌË 922 ·ÓÎÌË(485 Ï˙ÊÂ Ë 437 ÊÂÌË) Ò ÍÎËÌË˜ÌÓ ÒË„ÛÌ‡ ‰Ë‡„ÌÓÁ‡ èÅ ÔÓÍËÚÂËËÚÂ Ì‡ ãÓÌ‰ÓÌÒÍËfl ËÌÒÚËÚÛÚ ◊åÓÁ˙˜Ì‡ ·‡ÌÍ‡”,Ì‡ ‚˙Á‡ÒÚ ÓÚ 46 ‰Ó 96 „Ó‰ËÌË, ÒÂ‰Ì‡ ‚˙Á‡ÒÚ 73.76„.±0.25.

ëÚÂÔÂÌÚ‡ Ì‡ ‰‚Ë„‡ÚÂÎÌ‡Ú‡ ËÌ‚‡ÎË‰ËÁ‡ˆËfl ·Â¯Â ÓÔÂ-‰ÂÎÂÌ‡ ÔÓ ÒÍ‡Î‡Ú‡ Ì‡ Schwab-Endland.

íÂÊÂÒÚÚ‡ Ì‡ ÍÓ„ÌËÚË‚ÌËÚÂ Ë ÂÏÓˆËÓÌ‡ÎÌËÚÂ Ì‡Û-¯ÂÌËfl ·flı‡ ÓÔÂ‰ÂÎÂÌË ˜ÂÁ ˜‡ÒÚ I ◊åËÒÎÂÌÂ, ÔÓ‚Â‰ÂÌËÂ ËÂÏÓˆËË” Ì‡ UPDRS ÒÍ‡Î‡Ú‡. ë ÏÂÚÓ‰‡ Ì‡ ÍÓÂÎ‡ˆËÓÌÌËfl‡Ì‡ÎËÁ ËÁ˜ËÒÎËıÏÂ ÍÓÂÎ‡ˆËÓÌÌËfl ÍÓÂÙËˆËÂÌÚ (R), ÓÚ‡-Áfl‚‡˘ ÒËÎ‡Ú‡ Ë ÔÓÒÓÍ‡Ú‡ Ì‡ ‚˙ÁÍ‡Ú‡ ÏÂÊ‰Û ‰‚Ë„‡ÚÂÎ-ÌËÚÂ Ë ÍÓ„ÌËÚË‚ÌËÚÂ; ÏÂÊ‰Û ‰‚Ë„‡ÚÂÎÌËÚÂ Ë ÂÏÓˆËÓ-Ì‡ÎÌËÚÂ; ÏÂÊ‰Û ÍÓ„ÌËÚË‚ÌËÚÂ Ë ÂÏÓˆËÓÌ‡ÎÌË Ì‡Û¯Â-ÌËfl.

êÖáìãíÄíà: ë ‡ÁÎË˜Ì‡ ÒÚÂÔÂÌ Ì‡ Á‡‚ËÒËÏÓÒÚ ÓÚ˜ÛÊ‰‡ ÔÓÏÓ˘ ‚ ÂÊÂ‰ÌÂ‚Ì‡Ú‡ ‰‚Ë„‡ÚÂÎÌ‡ ‡ÍÚË‚ÌÓÒÚ Ò‡78.21% ÓÚ ·ÓÎÌËÚÂ Ò èÅ. éÚ Úflı ÚÂÊÍÓ ËÌ‚‡ÎË‰ËÁË‡-ÌË (Ì‡ ËÌ‚‡ÎË‰Ì‡ ÍÓÎË˜Í‡ ËÎË ÔËÍÓ‚‡ÌË Ì‡ ÎÂ„ÎÓ) Ò‡27.64%. èÓ-ÚÂÊÍ‡ ÒÚÂÔÂÌ Ì‡ ËÌ‚‡ÎË‰ËÁ‡ˆËfl ‚ ÂÊÂ‰ÌÂ‚-ÌËÚÂ ‰ÂÈÌÓÒÚË ÒÂ ÛÒÚ‡ÌÓ‚Ë ÔË ÊÂÌËÚÂ Ò èÅ ‚ Ò‡‚ÌÂ-ÌËÂ Ò Ï˙ÊÂÚÂ (χ2=16.207, =0.063).

äÓ„ÌËÚË‚ÂÌ ÛÔ‡‰˙Í, ‚ÍÎ˛˜‚‡˘ ËÌÚÂÎÂÍÚÛ‡ÎÌ‡ ÔÓÏfl-Ì‡ Ë Ì‡Û¯ÂÌËfl ‚ ÏËÒÎÂÌÂÚÓ, Ì‡ÏÂËıÏÂ Ò˙ÓÚ‚ÂÚÌÓ ÔË72.99% Ë 65.08% ÓÚ ËÁÒÎÂ‰‚‡ÌËÚÂ ·ÓÎÌË. ë ÛÏÂÂÌÓÚÂÊÍ‡ Ë ÚÂÊÍ‡ ËÌÚÂÎÂÍÚÛ‡ÎÌ‡ ÔÓÏflÌ‡ ·flı‡ 8.79%, ‡Ò˙Ò Ò˙˘‡Ú‡ ÚÂÊÂÒÚ Ì‡ Ì‡Û¯ÂÌËfl ‚ ÏËÒÎÂÌÂÚÓ – 14.1%ÓÚ ·ÓÎÌËÚÂ.

ÖÏÓˆËÓÌ‡ÎÌË Ì‡Û¯ÂÌËfl – ÔÓfl‚Ë Ì‡ ‰ÂÔÂÒËfl Ò˙Ó·˘‡-‚‡ı‡ 57.37%, ‡ Ì‡Û¯ÂÌËfl ‚ ÏÓÚË‚‡ˆËflÚ‡ – 53.36% ÓÚ·ÓÎÌËÚÂ. ìÏÂÂÌÓ ÚÂÊÍ‡ Ë ÚÂÊÍ‡ ‰ÂÔÂÒËfl ÛÒÚ‡ÌÓ‚Ëı-ÏÂ ÔË 20%, ‡ ÛÏÂÂÌÓ ËÁ‡ÁÂÌË Ì‡Û¯ÂÌËfl ‚ ÏÓÚË‚‡ˆË-flÚ‡ ÔË 25.06% ÓÚ ‚ÒË˜ÍË ·ÓÎÌË.

ÅÂ¯Â ÛÒÚ‡ÌÓ‚ÂÌ‡ ÒÂ‰ÌÓÒÚÂÔÂÌÌ‡ ÍÓÂÎ‡ˆËÓÌÌ‡ ‚˙Á-Í‡ ÏÂÊ‰Û ‰‚Ë„‡ÚÂÎÌËÚÂ Ë ÍÓ„ÌËÚË‚ÌËÚÂ (R=0.510,<0.01); ÏÂÊ‰Û ‰‚Ë„‡ÚÂÎÌËÚÂ Ë ÂÏÓˆËÓÌ‡ÎÌËÚÂ(R=0.500, <0.01); ÏÂÊ‰Û ÍÓ„ÌËÚË‚ÌËÚÂ Ë ÂÏÓˆËÓÌ‡ÎÌË-ÚÂ (R=0.550, <0.01) Ì‡Û¯ÂÌËfl.

áÄäãûóÖçàÖ: èÓ‚Â‰ÂÌÓ ËÁÒÎÂ‰‚‡ÌÂ ÍÓÎË˜ÂÒÚ‚ÂÌÓÓÔÂ‰ÂÎfl Ë ÔÓÚ‚˙Ê‰‡‚‡, ˜Â èÅ ‚Ó‰Ë ‰Ó ÁÌ‡˜ËÚÂÎÌ‡ ‰‚Ë-„‡ÚÂÎÌ‡ Ë ÔÒËıË˜Ì‡ ËÌ‚‡ÎË‰ËÁ‡ˆËfl, Ò‚˙Á‡ÌË ‚ ÔÓÓ˜ÂÌÍ˙„, ÓÔÂ‰ÂÎfl˘Ë „ÓÎflÏ‡Ú‡ ÒÓˆË‡ÎÌÓ-ËÍÓÌÓÏË˜ÂÒÍ‡ ÁÌ‡-˜ËÏÓÒÚ Ì‡ ÚÓ‚‡ Á‡·ÓÎfl‚‡ÌÂ.

äãûóéÇà Ñìåà: è‡ÍËÌÒÓÌÓ‚‡ ·ÓÎÂÒÚ, ‰‚Ë„‡ÚÂÎÌ‡ËÌ‚‡ÎË‰ËÁ‡ˆËfl, ÍÓ„ÌËÚË‚ÌÓ-ÂÏÓˆËÓÌ‡ÎÌË Ì‡Û¯ÂÌËfl, ÍÓ-ÂÙËˆËÂÌÚ Ì‡ ÍÓÂÎ‡ˆËfl.

ÇöÇÖÑÖçàÖ

è‡ÍËÌÒÓÌÓ‚‡Ú‡ ·ÓÎÂÒÚ Â ıÓÌË˜ÌÓ ÔÓ„ÂÒË‡˘Ó Á‡-·ÓÎfl‚‡ÌÂ Ì‡ ˆÂÌÚ‡ÎÌ‡Ú‡ ÌÂ‚Ì‡ ÒËÒÚÂÏ‡. éÒÌÓ‚ÌËÚÂÍÎËÌË˜ÌË ÔÓfl‚Ë Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ Ò‡ ‰‚Ë„‡ÚÂÎÌËÚÂ Ì‡Û-¯ÂÌËfl. Ç ‡ÌÌËÚÂ ÒÚ‡‰ËË Ì‡ èÅ fl‰Ó Ì‡ ÍÎËÌË˜Ì‡Ú‡ Í‡-ÚËÌ‡ Â ÓÚÌÓÒËÚÂÎÌÓ ˜ËÒÚ ‡ÒËÏÂÚË˜ÂÌ Ô‡ÍËÌÒÓÌÓ‚ÒËÌ‰ÓÏ ÔÂ‰ÒÚ‡‚ÂÌ ÓÚ ˜ÂÚËË Í‡‰ËÌ‡ÎÌË ÒËÏÔÚÓÏ‡ –·‡‰ËÍËÌÂÁËfl, Ë„Ë‰ÌÓÒÚ, ÚÂÏÓ Ë ÔÓÒÚÛ‡ÎÌ‡ ÌÂÒÚ‡-·ËÎÌÓÒÚ. íÂÊÂÒÚÚ‡ Ì‡ ÚÂÁË ÒËÏÔÚÓÏË ÓÔÂ‰ÂÎfl ÒÚÂ-ÔÂÌÚ‡ Ì‡ ‰‚Ë„‡ÚÂÎÌ‡Ú‡ ËÌ‚‡ÎË‰ËÁ‡ˆËfl Ì‡ ·ÓÎÌËÚÂ.(1,15,16)

èÓ„ÂÒËflÚ‡ Ì‡ ÌÂ‚Ó‰Â„ÂÌÂ‡ÚË‚ÌËfl ÔÓˆÂÒ ËÔÓ‰˙ÎÊËÚÂÎÌ‡Ú‡ ÎÂ‚Ó‰ÓÔ‡ ÚÂ‡ÔËfl ‰Ó·‡‚flÚ Í˙Ï Í‡-‰ËÌ‡ÎÌËÚÂ ÒËÏÔÚÓÏË Ë Í‡˜ÂÒÚ‚ÂÌÓ ÌÓ‚ ÚËÔ ‰‚Ë„‡ÚÂÎÌËÌ‡Û¯ÂÌËfl – ‰‚Ë„‡ÚÂÎÌË ÙÎÛÍÚÛ‡ˆËË, ‰ËÒÍËÌÂÁËË, ÙÂÌÓ-ÏÂÌË Ì‡ ◊Á‡Ï˙Á‚‡ÌÂ”, Ô‡‰‡ÌËfl. ë ÔÓfl‚‡Ú‡ ËÏ Ì‡‡ÒÚ‚‡ÒÚÂÔÂÌÌ‡ Ì‡ ‰‚Ë„‡ÚÂÎÌ‡Ú‡ ËÌ‚‡ÎË‰ËÁ‡ˆËfl. (4,13,14,26)

çÂÁ‡‚ËÒËÏÓ, ˜Â Á‡·ÓÎfl‚‡ÌÂÚÓ ÏÓÊÂ ‰‡ Á‡ÔÓ˜ÌÂ Ò ·‡-‰ËÔÒËıËfl, ÍÓ„ÌËÚË‚ÌËÚÂ Ë ÂÏÓˆËÓÌ‡ÎÌËÚÂ Ì‡Û¯ÂÌËfl Ò‡ı‡‡ÍÚÂÌË Á‡ ÔÓ-Ì‡ÔÂ‰Ì‡ÎËÚÂ ÒÚ‡‰ËË Ì‡ èÅ. íÂ ÏÓ„‡Ú‰‡ ·˙‰‡Ú ÔÓ-ËÌ‚‡ÎË‰ËÁË‡˘Ë Ë ÓÚ ÏÓÚÓÌËÚÂ. (25)

äÓ„ÌËÚË‚ÌËÚÂ Ì‡Û¯ÂÌËfl ÔË èÅ ÒÂ ı‡‡ÍÚÂËÁË‡ÚÒ˙Ò Á‡·‡‚flÌÂ Ì‡ ÏËÒÎÓ‚ÌËfl ÔÓˆÂÒ, Ì‡Û¯ÂÌÓ ‡·ÒÚ‡ÍÚÌÓÏËÒÎÂÌÂ Ë ÚÛ‰ÌÓÒÚË ‚˙‚ ‚˙ÁÔËflÚËflÚ‡. íÂ Ì‡Û¯‡‚‡ÚÌÂ Ò‡ÏÓ ÂÊÂ‰ÌÂ‚ÌËÚÂ ‰ÂÈÌÓÒÚË, ÌÓ Ë ˆÂÎËfl ÊË‚ÓÚ Ì‡·ÓÎÌËÚÂ, Á‡Òfl„‡ÈÍË ‡ÁÎË˜ÌË ÌÂ„Ó‚Ë ÍÓÏÔÓÌÂÌÚË. (10) ãÂ-ÍË ÍÓ„ÌËÚË‚ÌË Ì‡Û¯ÂÌËfl ËÏ‡Ú ÔÓ‚Â˜Â ÓÚ 50% ÓÚ ·ÓÎ-ÌËÚÂ Ò èÅ. éÍ‡˜ÂÒÚ‚ÂÌËÚÂ Í‡ÚÓ ‰ÂÏÂÌˆËfl ÍÓ„ÌËÚË‚ÌËÌ‡Û¯ÂÌËfl, ÒÔÓÂ‰ ÔÓ‚Â˜ÂÚÓ ‡‚ÚÓË, ÒÂ ÒÂ˘‡Ú ÔË ÓÍÓ-ÎÓ 20% ÓÚ ·ÓÎÌËÚÂ. (3,8,19, 24)

ÑÂÔÂÒËflÚ‡ Ë Ì‡Û¯ÂÌËflÚ‡ ‚ ÏÓÚË‚‡ˆËflÚ‡ Ò‡ ˜ÂÒÚÓÒÂ˘‡ÌË ÔË èÅ. íÂ ÒÂ ÔÓfl‚fl‚‡Ú Ò ‡Ô‡ÚËfl, ÔÒËıÓÏÓÚÓ-ÌÓ Á‡·‡‚flÌÂ, ÒÌËÊÂÌ‡ ËÌËˆË‡ÚË‚ÌÓÒÚ, ‡ ÔÓÌflÍÓ„‡ Ë Ò˙ÒÒÛËˆË‰ÌË Ë‰ÂË. (2)

ìÒÚ‡ÌÓ‚ÂÌÓ Â, ˜Â ÓÍÓÎÓ 50% ÓÚ Ô‡ˆËÂÌÚËÚÂ Ò èÅ ‚ ÓÔ-Â‰ÂÎÂÌË ÔÂËÓ‰Ë ÓÚ ‡Á‚ËÚËÂÚÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ ÒÚ‡-‰‡Ú ÓÚ ‰ÂÔÂÒËfl. (7) Ö‰Ì‡ ˜‡ÒÚ ÓÚ Úflı ËÏ‡Ú ÎÂÍË ‰ÂÔ-ÂÒË‚ÌË ÔÓfl‚Ë, ‡ ‰Û„Ë ÚÂÊÍ‡ ‰ÂÔÂÒËfl. Ñ‡ÌÌËÚÂ Á‡ ˜ÂÒ-ÚÓÚ‡Ú‡ Ì‡ ÛÏÂÂÌÓ ÚÂÊÍ‡Ú‡ Ë ÚÂÊÍ‡Ú‡ ‰ÂÔÂÒËfl Ò‡ÔÓÚË‚ÓÂ˜Ë‚Ë Ë ÒÔÓÂ‰ ‡ÁÎË˜ÌËÚÂ ‡‚ÚÓË ‚‡Ë‡Ú ÓÚ8 ‰Ó 46%.

èÓÛ˜‚‡ÌËflÚ‡ ÓÔÂ‰ÂÎËÎË ‚˙ÁÍ‡Ú‡ ÏÂÊ‰Û ÂÊÂ‰ÌÂ‚-Ì‡Ú‡ ÙËÁË˜ÂÒÍ‡ ‡ÍÚË‚ÌÓÒÚ Ë ‰ÂÔÂÒËfl Ò‡ ÛÒÚ‡ÌÓ‚ËÎË, ˜ÂÚfl ‚ÂÓflÚÌÓ Â ‰‚ÛÔÓÒÓ˜Ì‡. (12)

èË Ô‡ˆËÂÌÚË Ò ËÁ‡ÁÂÌ‡ ‡ÍËÌÂÁËfl Ë ÔÓÒÚÛ‡ÎÌ‡ ÌÂÒ-Ú‡·ËÎÌÓÒÚ ‰ÂÔÂÒËflÚ‡ Â ÔÓ-ËÁ‡ÁÂÌ‡. (23) ë‡Ï‡Ú‡ ‰ÂÔ-ÂÒËfl ÓÍ‡Á‚‡ ‚ÎËflÌËÂ ÌÂ Ò‡ÏÓ ‚˙ıÛ ÙËÁË˜ÂÒÍ‡Ú‡ ‡ÍÚË‚-ÌÓÒÚ Ë ÂÊÂ‰ÌÂ‚ÌËÚÂ ‰ÂÈÌÓÒÚË, ÌÓ Ë ‚˙ıÛ ÒÓˆË‡ÎÌ‡Ú‡ÔËÒÔÓÒÓ·ËÏÓÒÚ Ì‡ ·ÓÎÌËÚÂ. (20) éÚ ‰Û„‡ ÒÚ‡Ì‡ Â ÛÒ-Ú‡ÌÓ‚ÂÌÓ, ˜Â ÍÓ„‡ÚÓ ÒÂ Ì‡ÏÂÒË ‰ÂÔÂÒËflÚ‡ ÍÓ„ÌËÚË‚ÌË-ÚÂ ÙÛÌÍˆËË ÒÂ Ì‡Û¯‡‚‡Ú ‚ ÔÓ-ÚÂÊÍ‡ ÒÚÂÔÂÌ. (5,21)

ñÖã

ñÂÎÚ‡ Ì‡ ÔÓÛ˜‚‡ÌÂÚÓ ·Â¯Â ‰‡ ÒÂ ÓÔÂ‰ÂÎË ÒÚÂÔÂÌÚ‡Ì‡ ‰‚Ë„‡ÚÂÎÌ‡Ú‡ ËÌ‚‡ÎË‰ËÁ‡ˆËfl ‚ ÂÊÂ‰ÌÂ‚ÌËÚÂ ‰ÂÈÌÓÒ-ÚË, ÚÂÊÂÒÚÚ‡ Ì‡ ÍÓ„ÌËÚË‚ÌËÚÂ, ÂÏÓˆËÓÌ‡ÎÌËÚÂ Ì‡Û-¯ÂÌËfl Ë ÒÂ ÛÒÚ‡ÌÓ‚Ë ı‡‡ÍÚÂ‡ Ë ÒËÎ‡Ú‡ Ì‡ ÚflıÌ‡Ú‡‚˙ÁÍ‡ ÔË ·ÓÎÌË Ò èÅ.

åÄíÖêàÄã à åÖíéÑàäÄ

é·ÂÍÚ Ì‡ ÔÓÛ˜‚‡ÌÂÚÓ ·flı‡ 922 ·ÓÎÌË Ò ÍÎËÌË˜ÌÓ ÒË-„ÛÌ‡ ‰Ë‡„ÌÓÁ‡ èÅ ÔÓ ÍËÚÂËËÚÂ Ì‡ ãÓÌ‰ÓÌÒÍË ËÌÒÚË-


ÚÛÚ ◊åÓÁ˙˜Ì‡ ·‡ÌÍ‡”. àÁÒÎÂ‰‚‡ÌËÚÂ ÎËˆ‡ Ò‡ ÂÔÂÁÂÌ-Ú‡ÚË‚Ì‡ ËÁ‚‡‰Í‡ (45%) ÓÚ Â„ËÒÚË‡ÌËÚÂ Ò ÚÓ‚‡ Á‡·Ó-Îfl‚‡ÌÂ Ì‡ ÚÂËÚÓËflÚ‡ Ì‡ èÎÓ‚‰Ë‚ÒÍ‡ Ó·Î‡ÒÚ ÔÂÁ ÔÂ-ËÓ‰‡ 2002-2004 „. àÁ‚‡‰Í‡Ú‡ Â ÒÙÓÏË‡Ì‡ ÔÓ ÏÂÚÓ‰‡Ì‡ ÒÎÛ˜‡ÈÌËfl ÔÓ‰·Ó ÓÚ Ò˙Á‰‡‰ÂÌËfl ÓÚ Ì‡Ò Â„ËÒÚ˙ Ì‡·ÓÎÌËÚÂ Ò èÅ ‚ Ú‡ÁË Ó·Î‡ÒÚ, Ò ˜ËÒÎÂÌÓÒÚ Ì‡ Ì‡ÒÂÎÂÌËÂ-ÚÓ 715 904 ‰Û¯Ë. ãË˜ÌÓÒÚÓ‚ËÚÂ Ë ‰ÂÏÓ„‡ÙÒÍË ı‡‡Í-ÚÂËÒÚËÍË Ì‡ ËÁÒÎÂ‰‚‡ÌËÚÂ ·ÓÎÌË Ò‡ ÔÓÒÓ˜ÂÌË ‚ Ú‡·Î.1.

èË ËÁÒÎÂ‰‚‡ÌÂÚÓ Ë Ó·‡·ÓÚÍ‡Ú‡ Ì‡ ‰‡ÌÌËÚÂ ·flı‡ ËÁ-ÔÓÎÁ‚‡ÌË ÒÎÂ‰ÌËÚÂ Â‚ËÒÚË˜ÌË Ë ÒÚ‡ÚËÒÚË˜ÂÒÍË ÏÂÚÓ‰Ë:

● ëÚÂÔÂÌÚ‡ Ì‡ ‰‚Ë„‡ÚÂÎÌ‡Ú‡ ËÌ‚‡ÎË‰ËÁ‡ˆËfl ‚ ÂÊÂ‰-ÌÂ‚ÌËÚÂ ‰ÂÈÌÓÒÚË ·Â¯Â ÓÔÂ‰ÂÎÂÌ‡ ÔÓ ÒÍ‡Î‡Ú‡ Ì‡Schwab-England

● íÂÊÂÒÚÚ‡ Ì‡ ÍÓ„ÌËÚË‚ÌËÚÂ Ë ÂÏÓˆËÓÌ‡ÎÌËÚÂ Ì‡Û-¯ÂÌËfl ÓÔÂ‰ÂÎËıÏÂ ˜ÂÁ ˜‡ÒÚ I ◊åËÒÎÂÌÂ, ÔÓ‚Â‰ÂÌËÂË ÂÏÓˆËË” Ì‡ UPDRS-ÒÍ‡Î‡Ú‡

● åÂÚÓ‰˙Ú Ì‡ ‡ÎÚÂÌ‡ÚË‚ÌËflÚ ‡Ì‡ÎËÁ ·Â ËÁÔÓÎÁ‚‡ÌÁ‡ ËÁ˜ËÒÎÂÌËÂ Ë ÓˆÂÌÍ‡ Ì‡ ÓÚÌÓÒËÚÂÎÌËflÚ ‰flÎ ËÒÚ‡Ì‰‡ÚÌ‡Ú‡ „Â¯Í‡ Ì‡ ÔÓÍ‡Á‡ÚÂÎËÚÂ

● Fisher’s exaÒt test ËÁÔÓÎÁ‚‡ıÏÂ Á‡ ÓÔÂ‰ÂÎflÌÂ Ì‡ ÒÚ‡-ÚËÒÚË˜ÂÒÍË ÁÌ‡˜ËÏÓ ‡ÁÎË˜ËÂ ‚ ‡ÁÔÂ‰ÂÎÂÌËÂÚÓ Ì‡Ì‡Û¯ÂÌËflÚ‡ Ì‡ ‰‚Ë„‡ÚÂÎÌ‡Ú‡ ‡ÍÚË‚ÌÓÒÚ ‚ ÂÊÂ‰-

ÌÂ‚ËÂÚÓ ÔÓ ÔÓÎ● óÂÁ ÏÂÚÓ‰‡ Ì‡ ÍÓÂÎ‡ˆËÓÌÌËfl ‡Ì‡ÎËÁ ·Â¯Â ËÁ˜ËÒÎÂÌ

ÍÓÂÎ‡ˆËÓÌÌËfl ÍÓÂÙËˆËÂÌÚ (R), ÓÔÂ‰ÂÎfl˘ ÒËÎ‡Ú‡Ì‡ ‚˙ÁÍ‡Ú‡ ÏÂÊ‰Û ‰‚Ë„‡ÚÂÎÌËÚÂ Ë ÍÓ„ÌËÚË‚ÌËÚÂ;‰‚Ë„‡ÚÂÎÌËÚÂ Ë ÂÏÓˆËÓÌ‡ÎÌËÚÂ; ÍÓ„ÌËÚË‚ÌËÚÂ ËÂÏÓˆËÓÌ‡ÎÌË Ì‡Û¯ÂÌËfl.

ëÚ‡ÚËÒÚË˜ÂÒÍ‡Ú‡ Ó·‡·ÓÚÍ‡ Á‡ ÔÓÎÛ˜‡‚‡ÌÂ Ì‡ ÒÚÓÈ-ÌÓÒÚËÚÂ Ì‡ ÔÓÍ‡Á‡ÚÂÎËÚÂ ·Â¯Â ËÁ‚˙¯ÂÌ‡ Ò ÔÓÏÓ˘Ú‡Ì‡ ÒÓÙÚÛÂÂÌ Ô‡ÍÂÚ SPSS v.11.0. É‡ÙË˜ÌËflÚ ‡Ì‡ÎËÁ ·Â-¯Â ËÁ‚˙¯ÂÌ Ò ÔÓÏÓ˘Ú‡ Ì‡ Microsoft Excel, 2000.

êÖáìãíÄíà

ëÚÂÔÂÌÚ‡ Ì‡ ‰‚Ë„‡ÚÂÎÌ‡Ú‡ ‡ÍÚË‚ÌÓÒÚ ‚ ÂÊÂ‰ÌÂ‚ËÂ-ÚÓ ÔÓ ÒÍ‡Î‡Ú‡ Ì‡ Schwab-England Â ‡ÌÊË‡Ì‡ ÓÚ 100%‰Ó 10%. ç‡ 100% Ò˙ÓÚ‚ÂÚÒÚ‚‡ ÌÓÏ‡ÎÌ‡ ÂÊÂ‰ÌÂ‚Ì‡ ‡Í-ÚË‚ÌÓÒÚ, ‡ Ì‡ 20 Ë 10% ÚÂÊÍ‡ ËÌ‚‡ÎË‰ËÁ‡ˆËfl. èÓÎÛ˜ÂÌË-ÚÂ ÂÁÛÎÚ‡ÚË ÓÚ ËÁÒÎÂ‰‚‡ÌÂÚÓ Ò‡ ÔÂ‰ÒÚ‡‚ÂÌË ‚Ú‡·Î.2.

Ñ‡ÌÌËÚÂ ÔÓÍ‡Á‚‡Ú, ˜Â:● Ò‡ÏÓ 6.94% ÓÚ ËÁÒÎÂ‰‚‡ÌËflÚ ÍÓÌÚËÌ„ÂÌÚ ·ÓÎÌË Ò

èÅ Ò‡ Ò ÌÓÏ‡ÎÌ‡ (100%) ÂÊÂ‰ÌÂ‚Ì‡ ‰‚Ë„‡ÚÂÎÌ‡ ‡Í-ÚË‚ÌÓÒÚ;

● ÌÂÁ‡‚ËÒËÏË ‚ ÂÊÂ‰ÌÂ‚ÌËÚÂ ‰ÂÈÌÓÒÚË (90% Ë 80%),ÌÓ ËÁ‚˙¯‚‡˘Ë ÌflÍÓÈ ÓÚ ÚÂÁË ‰ÂÈÌÓÒÚË Ò˙Ò Á‡·‡‚Â-ÌÓÒÚ Ë Á‡ÚÛ‰ÌÂÌËÂ – 14.85% ÓÚ ·ÓÎÌËÚÂ;

● ‡ÁÎË˜Ì‡ ÒÚÂÔÂÌ Ì‡ Á‡‚ËÒËÏÓÒÚ ÓÚ ˜ÛÊ‰‡ ÔÓÏÓ˘ ‚ÂÊÂ‰ÌÂ‚ËÂÚÓ (ÓÚ 70% ‰Ó 10%) ËÏ‡Ú 78.21%;

● ÓÚ ‚ÒË˜ÍË Á‡‚ËÒËÏË ÓÚ ˜ÛÊ‰‡ ÔÓÏÓ˘ Ò ÚÂÊÍ‡ ËÎËÔ˙ÎÌ‡ ËÌ‚‡ÎË‰ÌÓÒÚ (‚ ËÌ‚‡ÎË‰Ì‡ ÍÓÎË˜Í‡ ËÎË ÔËÍÓ-‚‡ÌË Ì‡ ÎÂ„ÎÓ) Ò‡ 27.64% ÓÚ ·ÓÎÌËÚÂ.

ìÒÚ‡ÌÓ‚Ë ÒÂ, ˜Â ÔË ÊÂÌËÚÂ ‰‚Ë„‡ÚÂÎÌ‡Ú‡ ‡ÍÚË‚-ÌÓÒÚ ‚ ÂÊÂ‰ÌÂ‚ËÂÚÓ Â Ó„‡ÌË˜ÂÌ‡ ‚ ÔÓ-‚ËÒÓÍ‡ ÒÚÂÔÂÌ ‚Ò‡‚ÌÂÌËÂ Ò Ï˙ÊÂÚÂ Ë ‡ÁÎË˜ËÂÚÓ Â ÒÚ‡ÚËÒÚË˜ÂÒÍË ÁÌ‡-˜ËÏÓ (χ2=16.207; =0.063).

íÂÊÂÒÚÚ‡ Ì‡ ÍÓ„ÌËÚË‚ÌËÚÂ Ë ÂÏÓˆËÓÌ‡ÎÌËÚÂ Ì‡Û-¯ÂÌËfl ·Â ÓˆÂÌÂÌ‡ ˜ÂÁ ˜‡ÒÚ 1 Ì‡ UPDRS-ÒÍ‡Î‡Ú‡ ‚ ÔÂÚÒÚÂÔÂÌË Í‡ÚÓ: 0 – ÎËÔÒ‚‡˘Ë, 1 – ÎÂÍË, 2- ÛÏÂÂÌË, 3 ÛÏÂ-ÂÌÓ ÚÂÊÍË Ë 4 – ÚÂÊÍË. êÂÁÛÎÚ‡ÚËÚÂ Ò‡ ÔÂ‰ÒÚ‡‚ÂÌË ‚Ú‡·Î.3.

èË ËÁÒÎÂ‰‚‡ÌÂÚÓ ÒÂ ÛÒÚ‡ÌÓ‚Ë, ˜Â:● äÓ„ÌËÚË‚ÌË Ì‡Û¯ÂÌËfl, ‚ÍÎ˛˜‚‡˘Ë ËÌÚÂÎÂÍÚÛ‡ÎÌ‡

ÔÓÏflÌ‡ Ë Ì‡Û¯ÂÌËfl ‚ ÏËÒÎÂÌÂÚÓ ËÏ‡Ú Ò˙ÓÚ‚ÂÚ-ÌÓ 72.99% Ë 65.08% ÓÚ ·ÓÎÌËÚÂ Ò èÅ. éÚ Úflı ÒÛÏÂÂÌÓ ÚÂÊÍ‡ ËÌÚÂÎÂÍÚÛ‡ÎÌ‡ ÔÓÏflÌ‡ Ò‡ 8.79%, ‡Ò˙Ò Ò˙˘‡Ú‡ ÒÚÂÔÂÌ Ì‡Û¯ÂÌËfl ‚ ÏËÒÎÂÌÂÚÓ – 14.1%


í‡·Î.1. ãË˜ÌÓÒÚÓ‚Ë Ë ‰ÂÏÓ„‡ÙÒÍË ı‡‡ÍÚÂËÒÚËÍË Ì‡ ËÁÒÎÂ‰‚‡ÌËflÍÓÌÚËÌ„ÂÌÚ ·ÓÎÌË Ò èÅ

è‡‡ÏÂÚË ê‡ÁÏ‡ı ëÂ‰Ì‡ ëÚ‡Ì‰‡ÚÌ‡n=922 ‚˙Á‡ÒÚ „Â¯Í‡ï‡‡ÍÚÂËÒÚËÍË1. Ñ‡‚ÌÓÒÚ Ì‡ èÅ 1-17 6-68 0.092. Ç˙Á‡ÒÚ 46-96 73.76 0.25éÚ Úflı ÅÓÈ % SPÔÓ‰ 65 „. ‚˙Á‡ÒÚ 82 8.89 0.94Ì‡‰ 65 „. ‚˙Á‡ÒÚ 840 91.11 0.943. èÓÎ- Ï˙ÊÂ 485 52.60 1.64- ÊÂÌË 437 47.40 1.644. åÂÒÚÓÊË‚ÂÂÌÂ- „‡‰ 640 69.41 1.52- ÒÂÎÓ 282 30.59 1.525. é·‡ÁÓ‚‡ÌËÂ- ·ÂÁ Ó·‡ÁÓ‚‡ÌËÂ 1.7 1.84 0.44- Ì‡˜‡ÎÌÓ 172 18.66 1.28- ÓÒÌÓ‚ÌÓ 352 38.18 1.60- ÒÂ‰ÌÓ 266 28.85 1.49- ‚ËÒ¯Â 115 12.47 1.09

● ÖÏÓˆËÓÌ‡ÎÌË Ì‡Û¯ÂÌËfl, ËÁ‡Áfl‚‡˘Ë ÒÂ Ò ‰ÂÔÂÒË‚-ÌË ÔÓfl‚Ë Ë Ì‡Û¯ÂÌ‡ ÏÓÚË‚‡ˆËfl Ò˙Ó·˘‡‚‡Ú Ò˙ÓÚ-‚ÂÚÌÓ 57.53% Ë 53.36% ÓÚ ËÁÒÎÂ‰‚‡ÌËfl ÍÓÌÚËÌ„ÂÌÚ·ÓÎÌË. íÂÁË Ò ÛÏÂÂÌÓ ÚÂÊÍ‡ Ë ÚÂÊÍ‡ (ÔÓ‰˙ÎÊË-ÚÂÎÌ‡ ËÎË ÔÓÒÚÓflÌÌ‡) ‰ÂÔÂÒËfl Ò‡ 20%, ‡ Ò ËÁ‡ÁÂÌËÌ‡Û¯ÂÌËfl ‚ ÏÓÚË‚‡ˆËflÚ‡ – 25.06%.

Ñ‡ÌÌËÚÂ ÓÚ ÍÓÂÎ‡ˆËÓÌÌËfl ‡Ì‡ÎËÁ Á‡ ÓÔÂ‰ÂÎflÌÂ ı‡-‡ÍÚÂ‡ Ë ‚˙ÁÍ‡Ú‡ ÏÂÊ‰Û ÒÚÂÔÂÌÚ‡ Ì‡ ‰‚Ë„‡ÚÂÎÌ‡Ú‡ ËÔÒËıË˜Ì‡ ËÌ‚‡ÎË‰ËÁ‡ˆËfl Ì‡ ·ÓÎÌËÚÂ Ò èÅ Ò‡ ÔÓÒÓ˜ÂÌË ‚Ú‡·Î.4.

ëÚÓÈÌÓÒÚËÚÂ Ì‡ ÍÓÂÎ‡ˆËÓÌÌËÚÂ ÍÓÂÙËˆËÂÌÚË ÔÓ-Í‡Á‚‡Ú Ì‡ÎË˜ËÂ Ì‡ ÒÂ‰Ì‡ ÒÚÂÔÂÌ Ì‡ ÍÓÂÎ‡ˆËÓÌÌ‡ ‚˙ÁÍ‡ÏÂÊ‰Û ‰‚Ë„‡ÚÂÎÌËÚÂ, ÍÓ„ÌËÚË‚ÌËÚÂ Ë ÂÏÓˆËÓÌ‡ÎÌË ÔÓ-fl‚Ë ÔË èÅ.

éÅëöÜÑÄçÖ

ëÓˆË‡ÎÌ‡Ú‡ ÁÌ‡˜ËÏÓÒÚ Ì‡ Â‰ÌÓ ıÓÌË˜ÌÓ Á‡·ÓÎfl‚‡ÌÂÒÂ ÓÔÂ‰ÂÎfl ÔÂ‰ËÏÌÓ ÓÚ ˜ÂÒÚÓÚ‡Ú‡ Ì‡ ÌÂ„Ó‚ÓÚÓ ‡ÁÔ-ÓÒÚ‡ÌÂÌËÂ Ë ËÌ‚‡ÎË‰ËÁ‡ˆËflÚ‡, ÍÓflÚÓ ÔË˜ËÌfl‚‡. é˘Â‚ ÚÛ‰Ó‚ÂÚÂ ÒË ÓÚ 1880 „. ò‡ÍÓ ÓÔÂ‰ÂÎfl ÓÔËÒ‡ÌÓÚÓÓÚ ÑÊÂÈÏÒ è‡ÍËÌÒÓÌ Á‡·ÓÎfl‚‡ÌÂ Í‡ÚÓ ÒÓˆË‡ÎÌÓ ÁÌ‡˜Ë-ÏÓ. (6) Ö‰‚‡ ÒÎÂ‰ ÏÌÓ„Ó·ÓÈÌËÚÂ ÂÔË‰ÂÏËÓÎÓ„Ë˜ÌË Ë ÍÎË-ÌË˜ÌË ÔÓÛ˜‚‡ÌËfl ÔÓ‚Â‰ÂÌË ÔÂÁ ‚ÚÓ‡Ú‡ ÔÓÎÓ‚ËÌ‡ Ì‡ïï ‚ÂÍ ÔË ÛÒÚ‡ÌÓ‚ÂÌ‡Ú‡ Ì‡‡ÒÚ‚‡˘‡ ˜ÂÒÚÓÚ‡Ú‡ Ì‡èÅ Ë ÁÌ‡˜ËÚÂÎÌ‡ ËÌ‚‡ÎË‰ËÁ‡ˆËfl Ì‡ „ÓÎflÏ ·ÓÈ ıÓ‡ ‚ Áfl-Î‡ Ë Í˙ÒÌ‡ ÒÂ‰Ì‡ ‚˙Á‡ÒÚ ‚ ÔÓÚÓÍÓÎËÚÂ Ì‡ ëáé ÓÚ1997 „. Á‡·ÓÎfl‚‡ÌÂÚÓ Â ‚ÔËÒ‡ÌÓ Í‡ÚÓ ÒÓˆË‡ÎÌÓ ÁÌ‡˜ËÏÓ.

Ç ÔÓ‰ÍÂÔ‡ Ì‡ ÒÓˆË‡ÎÌ‡Ú‡ ÁÌ‡˜ËÏÓÒÚ Ì‡ èÅ Ò‡ Ë ÂÁÛÎ-Ú‡ÚËÚÂ ÓÚ Ì‡ÒÚÓfl˘ÓÚÓ ÔÓÛ˜‚‡ÌÂ, ÔË ÍÓÂÚÓ ÛÒÚ‡ÌÓ-‚ËıÏÂ ‚ËÒÓÍ ÓÚÌÓÒËÚÂÎÂÌ ‰flÎ Ì‡ ·ÓÎÌËÚÂ Ò ◊ÎËÏËÚË‡-ÌÂ” Ì‡ ÂÊÂ‰ÌÂ‚Ì‡Ú‡ ‰‚Ë„‡ÚÂÎÌ‡ ‡ÍÚË‚ÌÓÒÚ – 78.21%. ë‡ÁÎË˜Ì‡ ÒÚÂÔÂÌ Ì‡ Á‡‚ËÒËÏÓÒÚ ÓÚ ˜ÛÊ‰‡ ÔÓÏÓ˘ ‚ ÂÊÂ‰-

ÌÂ‚ÌËÚÂ ÛÚËÌÌË ‰ÂÈÌÓÒÚË Ò‡ 57% ÓÚ ËÁÒÎÂ‰‚‡ÌËÚÂ ÓÚÌ‡Ò ·ÓÎÌË, ‡ Ò ÚÂÊÍ‡ ËÌ‚‡ÎË‰ËÁ‡ˆËfl, ËÁˆflÎÓ Á‡‚ËÒËÏÓ ÓÚ˜ÛÊ‰‡ ÔÓÏÓ˘ – 27.64%. ÅÂÁÒÔÓÌÓ ‚ËÒÓÍ‡Ú‡ ÒÂ‰Ì‡ ‚˙Á-‡ÒÚ (73.76 „.) Ì‡ ËÁÒÎÂ‰‚‡ÌËÚÂ ·ÓÎÌË, Í‡ÍÚÓ Ë „ÓÎflÏ‡Ú‡‰‡‚ÌÓÒÚ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ ËÏ (6.68 „.) Ò‡ Ù‡ÍÚÓË, ÓÍ‡Á‚‡-˘Ë ‚ÎËflÌËÂ ‚˙ıÛ ÒÚÂÔÂÌÚ‡ Ì‡ ‰‚Ë„‡ÚÂÎÌ‡Ú‡ ËÌ‚‡ÎË‰Ë-Á‡ˆËfl. íÓ‚‡ ÌÂ ËÁÍÎ˛˜‚‡ ÓÎflÚ‡ Ì‡ ÌÂ‰ÓÒÚ‡Ú˙˜ÌË Ò˙‚Â-ÏÂÌÌË ÏÂ‰ËÍ‡ÏÂÌÚÓÁÌË ÒÂ‰ÒÚ‚‡ Ë Âı‡·ËÎËÚ‡ˆËÓÌÌËÏÂÓÔËflÚËfl Á‡ ·ÓÎÌËÚÂ Ò èÅ ‚ Ì‡¯‡Ú‡ ÒÚ‡Ì‡.

ëÔÓÂ‰ ÌflÍÓÈ ‡‚ÚÓË ÔÓ-„ÓÎflÏÓ ‡ÁÌÓÓ·‡ÁËÂ Ì‡ ÂÊÂ‰-

ÌÂ‚ÌË ‰ÂÈÌÓÒÚË ÔË ÊÂÌËÚÂ, Í‡ÍÚÓ Ë ÔÓ-‡ÍÚË‚ÌÓÚÓ ËÏÛ˜‡ÒÚËÂ ‚ ‰ÓÏ‡ÍËÌÒÚ‚ÓÚÓ, Ò‡ ÔË˜ËÌ‡ ˜ÂÁ ÒÍ‡Î‡Ú‡ Ì‡Schwab-England ‰‡ ÒÂ ÓÚ˜ËÚ‡ ÔÓ-ÚÂÊÍ‡ ‰‚Ë„‡ÚÂÎÌ‡ ËÌ-‚‡ÎË‰ËÁ‡ˆËfl ÔË ÊÂÌËÚÂ Ò èÅ. (9)

íÓ‚‡ ÔÓÍ‡Á‚‡Ú Ë ÂÁÛÎÚ‡ÚËÚÂ ÓÚ Ì‡¯ÂÚÓ ÔÓÛ˜‚‡ÌÂ,ÔË ÍÓÂÚÓ ÛÒÚ‡ÌÓ‚ËıÏÂ ÒÚ‡ÚËÒÚË˜ÂÒÍË ÁÌ‡˜ËÏÓ ÔÓ-ÚÂÊÍ‡ ËÌ‚‡ÎË‰ËÁ‡ˆËfl ÔË ÊÂÌËÚÂ ‚ Ò‡‚ÌÂÌËÂ Ò Ï˙ÊÂÚÂ.

äÓ„ÌËÚË‚ÌËÚÂ Ì‡Û¯ÂÌËfl Ò‡ ‚‡ÊÌ‡ ˜‡ÒÚ ÓÚ ÍÎËÌË˜-Ì‡Ú‡ Í‡ÚËÌ‡ Ì‡ èÅ. èË ËÁ‡ÁÂÌ ÍÓ„ÌËÚË‚ÂÌ ‰ÂÙËˆËÚÒÂ ‚ÎÓ¯‡‚‡Ú ÂÊÂ‰ÌÂ‚ÌËÚÂ ÛÚËÌÌË ‰ÂÈÌÓÒÚË Í‡ÚÓ Ó·-ÎË˜‡ÌÂ, ı‡ÌÂÌÂ, ıË„ËÂÌ‡, ÍÓÂÚÓ Ô‡‚Ë ·ÓÎÌËÚÂ Á‡‚ËÒËÏËÓÚ ÚÂıÌËÚÂ ·ÎËÁÍË. ç‡‡ÒÚ‚‡ Ë ÒÍÎÓÌÌÓÒÚÚ‡ ËÏ Í˙Ï‰ÂÔÂÒË‚ÌË ÔÓfl‚Ë, ‡ ÍÓ„‡ÚÓ ÒÂ Ì‡ÏÂÒË ‰ÂÔÂÒËflÚ‡ÛÏÒÚ‚ÂÌËÚÂ ÒÔÓÒÓ·ÌÓÒÚË Ì‡ ·ÓÎÌËÚÂ ÒÂ ‚ÎÓ¯‡‚‡Ú Ó˘ÂÔÓ‚Â˜Â. (22,25)

ãÂÍ‡ ËÌÚÂÎÂÍÚÛ‡ÎÌ‡ ÔÓÏflÌ‡ ÛÒÚ‡ÌÓ‚ËıÏÂ ÔË64.20% ÓÚ ·ÓÎÌËÚÂ, ‡ ÎÂÍË Ì‡Û¯ÂÌËfl ‚ ÏËÒÎÂÌÂÚÓ – ÔË50.88%. Ñ‡ÌÌËÚÂ Ò‡ ·ÎËÁÍË ‰Ó ˆËÚË‡ÌËÚÂ ‚ ÎËÚÂ‡ÚÛ-‡Ú‡.

óÂÁ ˜‡ÒÚI Ì‡ UPDRS-ÒÍ‡Î‡Ú‡ ÓÔÂ‰ÂÎËıÏÂ, ˜Â Ò ÚÂÊ-ÍË ËÌÚÂÎÂÍÚÛ‡ÎÌË ÔÓÏÂÌË Ë ÚÂÊÍË Ì‡Û¯ÂÌËfl ‚ ÏËÒÎÂ-ÌÂÚÓ, ÓÍ‡˜ÂÒÚ‚ÂÌË Í‡ÚÓ ‰ÂÏÂÌˆËfl Ò‡ 8.79% Ë 14.1% ÓÚËÁÒÎÂ‰‚‡ÌËÚÂ ·ÓÎÌË. íÂÁË ÂÁÛÎÚ‡ÚË Ò‡ ÔÓ-ÌËÒÍË ÓÚ Ò˙-Ó·˘‡‚‡ÌËÚÂ ÓÚ ‰Û„Ë ‡‚ÚÓË ÓÚ 20% ‰Ó 40% Ë ÚÓ‚‡ ‚Â-ÓflÚÌÓ ÒÂ ‰˙ÎÊË Ì‡ ËÁÔÓÎÁ‚‡ÌËÚÂ ÓÚ Úflı ÔÓ-ÔÓ‰Ó·ÌË ËÒÔÂˆËÙË˜ÌË ÒÍ‡ÎË Á‡ ÔÂˆËÁË‡ÌÂ Ì‡ ÍÓ„ÌËÚË‚ÌËÚÂ ÙÛÌÍ-ˆËË. (3,8,15,18,25)

èÓÏÂÌËÚÂ ‚ Ì‡ÒÚÓÂÌËÂÚÓ, ÊËÁÌÂÌÓÒÚÚ‡ Ë ÏÓÚË‚‡-ˆËflÚ‡ ‡ÁÒÚÓÈ‚‡Ú ‚Á‡ËÏÓÓÚÌÓ¯ÂÌËflÚ‡ Ì‡ Ô‡ˆËÂÌÚË-ÚÂ Ò ÚÂıÌËÚÂ ·ÎËÁÍË, ÔËflÚÂÎË, ‚Ó‰flÚ ‰Ó Ò‡ÏÓËÁÓÎ‡ˆËfl,ÒÏÛ˘‡‚‡Ú ÒÓˆË‡ÎÌ‡Ú‡ ËÏ ÔËÒÔÓÒÓ·ËÏÓÒÚ ä‡ÚÓ ˆflÎÓÒÂ Ò˜ËÚ‡, ˜Â ÓÍÓÎÓ 50% ÓÚ Ô‡ˆËÂÌÚËÚÂ Ò èÅ ÒÚ‡‰‡ÚÓÚ ‰ÂÔÂÒËfl ‚ ÌflÍ‡Í˙‚ ÏÓÏÂÌÚ ÓÚ ‡Á‚ËÚËÂÚÓ Ì‡ Á‡·Ó-Îfl‚‡ÌÂÚÓ. (5,24)

Ç Ì‡¯ÂÚÓ ÔÓÛ˜‚‡ÌÂ Ò ‰ÂÔÂÒËfl Ò‡ 53%, ‡ Ò Ì‡Û¯ÂÌ‡ÏÓÚË‚‡ˆËflÚ‡ 57% ÓÚ ·ÓÎÌËÚÂ. Ç ÎËÚÂ‡ÚÛ‡Ú‡ ‰‡ÌÌË-


í‡·Î.4. ëËÎ‡ Ì‡ ‚˙ÁÍ‡ ÏÂÊ‰Û ÒÚÂÔÂÌÚ‡ Ì‡ ‰‚Ë„‡ÚÂÎÌ‡Ú‡ Ë ÔÒËıË˜Ì‡ËÌ‚‡ÎË‰ËÁ‡ˆËfl Ì‡ ·ÓÎÌËÚÂ Ò èÅ (ÍÓÂÎ‡ˆËÓÌÌË ÍÓÂÙËˆËÂÌÚË)

äÓÂÎ‡ˆËÓÌÌË ÔÓÍ‡Á‡ÚÂÎË äÓÂÎ‡ˆËÓÌÌËÍÓÂÙËˆËÂÌÚË

1. Ç˙ÁÍ‡ Ì‡ Ì‡Û¯ÂÌËflÚ‡ Ì‡ ÂÊÂ‰ÌÂ‚Ì‡Ú‡ ‰‚Ë„‡ÚÂÎÌ‡ ‡ÍÚË‚ÌÓÒÚ Ò ÍÓ„ÌËÚË‚ÌËÚÂ Ì‡Û¯ÂÌËfl R=0.510 p<0.012. 1. Ç˙ÁÍ‡ Ì‡ Ì‡Û¯ÂÌËflÚ‡ Ì‡ ÂÊÂ‰ÌÂ‚Ì‡Ú‡ ‰‚Ë„‡ÚÂÎÌ‡ ‡ÍÚË‚ÌÓÒÚ Ò ÂÏÓˆËÓÌ‡ÎÌËÚÂ Ì‡Û¯ÂÌËfl R=0.500 p<0.013. Ç˙ÁÍ‡ Ì‡ ÍÓ„ÌËÚË‚ÌËÚÂ Ë ÂÏÓˆËÓÌ‡ÎÌËÚÂ Ì‡Û¯ÂÌËfl R=0.550 p=0.01

ÚÂ Á‡ ˜ÂÒÚÓÚ‡Ú‡ Ì‡ ÛÏÂÂÌÓ ÚÂÊÍ‡Ú‡ Ë ÚÂÊÍ‡Ú‡ ‰ÂÔ-ÂÒËfl Ò‡ ÔÓÚË‚ÓÂ˜Ë‚Ë. ç‡¯ËÚÂ ÂÁÛÎÚ‡ÚË – 20% Ô‡-ˆËÂÌÚË Ò ÛÏÂÂÌÓ ÚÂÊÍ‡ Ë ÚÂÊÍ‡ ‰ÂÔÂÒËfl Ë 25% Ò ËÁ-‡ÁÂÌË Ì‡Û¯ÂÌËfl ‚ ÏÓÚË‚‡ˆËflÚ‡ Ò‡ ·ÎËÁÍË ‰Ó ÚÂÁË ÔÓ-ÎÛ˜ÂÌË ÔË ÔÓÛ˜‚‡ÌÂ ‚ ÇÂÎËÍÓ·ËÚ‡ÌËfl – 19.4% Ë îËÌ-Î‡Ì‰Ëfl – 24%. (11,19)

çflÍÓÈ ‡‚ÚÓË Ò‡ ËÁÛ˜‡‚‡ÎË ‚˙ÁÍ‡Ú‡ ÏÂÊ‰Û ‰‚Ë„‡-ÚÂÎÌËÚÂ ·ÂÎÂÁË ÔË èÅ Ë ˜ÂÒÚÓÚ‡Ú‡ Ë ÚÂÊÂÒÚÚ‡ Ì‡‰ÂÔÂÒËflÚ‡, ÌÓ ÌÂ Ò‡ ÓÚÍËÎË ÌflÍ‡Í‚‡ Ò˙˘ÂÒÚ‚ÂÌ‡ ÍÓÂ-Î‡ˆËfl. (5) ÑÛ„Ë ÔËÂÏ‡Ú, ˜Â ‚˙ÁÍ‡Ú‡ Â ‰‚ÛÔÓÒÓ˜Ì‡. (24)

çËÂ ÛÒÚ‡ÌÓ‚ËıÏÂ ÒÂ‰ÌÓÒÚÂÔÂÌÌ‡ ÍÓÂÎ‡ˆËÓÌÌ‡ ‚˙Á-Í‡ ÏÂÊ‰Û ÒÚÂÔÂÌÌ‡ Ì‡ ‰‚Ë„‡ÚÂÎÌ‡Ú‡ ËÌ‚‡ÎË‰ËÁ‡ˆËfl ËÚÂÊÂÒÚÚ‡ Ì‡ ‰ÂÔÂÒË‚ÌËÚÂ ÔÓfl‚Ë.

ëÚÓÈÌÓÒÚËÚÂ Ì‡ ÍÓÂÙËˆËÂÌÚ‡ Ì‡ ÍÓÂÎ‡ˆËfl ÏÂÊ‰Û‰‚Ë„‡ÚÂÎÌ‡Ú‡ ËÌ‚‡ÎË‰ËÁ‡ˆËfl Ë ÍÓ„ÌËÚË‚ÌËÚÂ Ì‡Û¯Â-ÌËfl Ë ÏÂÊ‰Û ÍÓ„ÌËÚË‚ÌËÚÂ Ë ÂÏÓˆËÓÌ‡ÎÌË Ì‡Û¯ÂÌËfl,ÓÔÂ‰ÂÎÂÌË ÔË ÚÓ‚‡ ÔÓÛ˜‚‡ÌÂ, Ò˙ÓÚ‚ÂÚÒÚ‚‡Ú Ì‡ ÚÂÁËÒ˙Ó·˘ÂÌË ÓÚ ÏÌÓ„Ó ‡‚ÚÓË. (3,18)


èÅ Ì‡Ì‡Òfl ÚÂÊÍË Ì‡Û¯ÂÌËfl Ì‡ ‰‚Ë„‡ÚÂÎÌ‡Ú‡ ‡ÍÚË‚-ÌÓÒÚ Ë ÔÒËıË˜ÌÓÚÓ Ò˙ÒÚÓflÌËÂ Ì‡ ·ÓÎÌËÚÂ. Ç ‡Á‚ËÚËÂ-ÚÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ ‰‚Ë„‡ÚÂÎÌ‡Ú‡ Ë ÔÒËıË˜Ì‡ ËÌ‚‡ÎË‰Ë-Á‡ˆËfl Ò‡ Ò‚˙Á‡ÌË ‚ ÔÓÓ˜ÂÌ Í˙„, ÓÔÂ‰ÂÎfl˘ ÒËÌıÓÌÌ‡-Ú‡ ËÏ ÔÓ„ÂÒËfl, ÍÓÂÚÓ ÒÂËÓÁÌÓ ‚ÎÓ¯‡‚‡ äÜ.

ë‡ÏÓ ÔËÎÓÊÂÌËÂÚÓ Ì‡ ÍÓÏÔÎÂÍÒÌËÚÂ ÏÂ‰ËÍ‡ÏÂÌÚÓÁÌËË ÌÂÏÂ‰ËÍ‡ÏÂÌÚÓÁÌË ÔÓ‰ıÓ‰Ë, ÍÓËÚÓ ·Ëı‡ ÔÓ‰Ó·ËÎË ‰‚Ë„‡-ÚÂÎÌ‡Ú‡ ‡ÍÚË‚ÌÓÒÚ Ë ÔÒËıË˜Ì‡Ú‡ ‰ËÒÙÛÌÍˆËfl ÔË ·ÓÎÌË-ÚÂ ·Ë ÔÓ‚ÎËflÎÓ ÔÓÎÓÊËÚÂÎÌÓ ‚˙ıÛ äÜ Ì‡ ·ÓÎÌËÚÂ Ò èÅ.

ãàíÖêÄíìêÄ1. åËÎ‡ÌÓ‚, à. è‡ÍËÌÒÓÌÓ‚Ë ÒËÌ‰ÓÏË. àÁ‰‡ÚÂÎÒÍ‡ Í˙˘‡ ëíÖçé, Ç‡Ì‡,

2005.2. íÓ‰ÓÓ‚‡, Ä. ä‡˜ÂÒÚ‚Ó Ì‡ ÊË‚ÓÚ ÔË è‡ÍËÌÒÓÌÓ‚‡ ·ÓÎÂÒÚ. Ñ‚Ë„‡ÚÂÎ-

ÌË Ì‡Û¯ÂÌËfl. 2006; 1:24-33.3. Adler, C.H. Nonmotor complication in Parkinson’s disease. Movement

Disorders, 2005, 20, Suppl.11, S23-S29.4. Adler, C.H. Relevance of motor complications in Parkinson’s disease.

Neurology, 2002, 58 Suppl. 1, S51-S56.5. Burn, David J. Beyong the iron mask: towards better recognition and treat-

ment of depression associated with Parkinson’s disease. Movement disorders2002; 17:445-454.

6. Charcot, J.M. De la paralyses agitans. In: Lecons sur maladies du systemenerveux. Paris, Delhaye et Lectosnier, 1880, 1-188.

7. Doneif, G., Mirabello, E., Bell, K., et al. An estimate of the incidence ofdepression in idiopathic Parkinson’s disease. Arch. Neurol., 1992, 49,305-307.

8. Emre, M. What causes mental dysfunction in Parkinson’s disease? Mov.Disord., 2003, 18, Suppl.6, S63-S71.

9. Foltynie, T., Levis. S., Barker RA. Your questions answered Parkinson’s dis-ease Churchill Livingston.2003.

10. Karlsen, K., Larsen, J., Tandberg, E., Jorgensen, K. Fatigue in patients withParkinson’s disease. Movement disorders 1999; 14:237-241.

11. Kuopio, A., Martilla, R., Helenius, H., Toivonen, M., Rinne, U. The qualityof life in Parkinson’s disease. Movement disorders 2000; 15:216-223.

12. Liu, C.Y., Wang, S.J., Fuh, J.L., Yang, Y.Y., Lui, H.C. The correlation ofdepression with functional activity in Parkinson’s disease. J Neurol 1997;244:493-498.

13. Olanow, C.W. Present and future directions in the management of motorcomplications in patients with advanced PD. Neurology, 2003, 61, Suppl. 3,S24-S33.

14. Onofi, J.M., Thomas, A. Acute akinesia in Parkinson’s disease. Neurology,2005, 64, 1162-1169.

15. Paulson, H.L., Stern, M.B. Clinical manifestations of Parkinson’s disease. In:Movement Disorders, Neurologic Principles and Practice. Eds.: Watts, R.L.,Koller, W.C., McGraw-Hill, New York, 2004, 233-245.

16. Paulson, H.L., Stern, M.B. Clinical manifestations of Parkinson’s disease.In:Movement Disorders. Neurologic Principles and Practice. Eds.: Watts, R.L.,Koller, W.C., McGraw-Hill, New York,1997,183-199.

17. Waters, C. Other pharmacological treatments for motor complications anddyskinesias. Movement Disorders, 2005, 20, Suppl. 11, S38-S44.

18. Schrag A. Psychiatric aspects of Parkinson’s disease. Journal of Neurology,2004, 251, 795-804.

19. Schrag, A., Jahanshani, M., Quinn, N., What contributes to quality of life inpatients with Parkinson’s disease? J Neurol Neurosurg Psychiary 2000; 69:308-312.

20. Shulman, L., Taback, R.L., Bean, J., Weiner, W. Comorbidity of the non-motor symptoms of Parkinson’s disease. Movement disorders 2001; 16:507-510.

21. Stern J., Marder K., Tang M-X., et al. Antecedent clinical features associatedwith dementia in Parkinson’s disease.Neurology,1993;42:1690-2.

22. Starkstein, S.E., Preziosi, T.J., Berthier, M.L., Bolduk, P.L., Mayberg, H.S.,Robinson, R.G. Depression and cognitive impairment in Parkinson’s disease.Brain 1989; 112:1141-1153.

23. Starkstein, S.E., Petracca, G., Chemerinski, E., et al. Depression in classicversus akinetic-rigid Parkinson’s disease. Movement disorders 1998; 13:29-33.

24. Starkstein, S.E., Mayberg, H.S., Leiguarda, R. et al. A prospective longitudi-nal study of depression, cognitive decline and physical impairments inpatients with Parkinson’s disease. J Neurol Neurosurg Psychiatry 1992;55:377-382.

25. Vingerhoets, G., Verleden, S., Santens, P., Miatton, M., De Reuck, J.Predictors of cognitive impairment in advanced Parkinson’s disease. J NeurolNeurosurg Psychiartry 2003; 74:793-796.

26. Waters, C. Other pharmacological treatments for motor complications anddyskinesias. Movement Disorders, 2005, 20, Suppl. 11, S38-S44.

Ä‰ÂÒ Á‡ ÍÓÂÒÔÓÌ‰ÂÌˆËfl:Ñ- ÑËÏÍ‡ ïËÒÚÓ‚‡, ‰ÓÍÚÓäÎËÌËÍ‡ ÔÓ ÌÂ‚ÓÎÓ„Ëfl, ìåÅÄã ◊ë‚. ÉÂÓ„Ë”åÂ‰ËˆËÌÒÍË ÛÌË‚ÂÒËÚÂÚ – èÎÓ‚‰Ë‚ÅÛÎ. ◊Ç‡ÒËÎ ÄÔËÎÓ‚” ‹ 15Ä4000 èÎÓ‚‰Ë‚GSM: 0886299529E-mail: [email protected]


ÑÓ êÂ‰‡ÍˆËflÚ‡ Ì‡ ÒÔ. ”Å˙Î„‡ÒÍ‡ çÂ‚ÓÎÓ„Ëfl”

ì‚‡Ê‡ÂÏ‡ êÂ‰‡ÍˆËfl,Ç ÓÚÔÂ˜‡ÚÂÌ‡Ú‡ ‚ ‡Á‰ÂÎ‡ ”In memoriam” ÒÚ‡ÚËfl Á‡ ÔÓÙ. çËÍÓÎ‡ òËÔÍÓ‚ÂÌÒÍË

(ÒÔ. ”Å˙Î„‡ÒÍ‡ çÂ‚ÓÎÓ„Ëfl”, Ú.7, ·ÓÈ 4) Ò‡ ‰ÓÔÛÒÌ‡ÚË ÒÎÂ‰ÌËÚÂ ÚÂıÌË˜ÂÒÍË „Â¯ÍË:

ç‡ ÒÚ. 206, ‚ÚÓ‡ ÍÓÎÓÌ‡, 15 Â‰ ÓÚ ‰ÓÎÛ:Ì‡ÔËÒ‡ÌÓ ”é·‡ÚÌÓ” - ‰‡ ÒÂ ˜ÂÚÂ ”éÚ‡‰ÌÓ”ç‡ ÒÚ. 207, ‚ÚÓ‡ ÍÓÎÓÌ‡, 20 Â‰ ÓÚ ‰ÓÎÛ:

Ì‡ÔËÒ‡ÌÓ ”Å‡ÌäÎÂ‚ÂÎÂÌ” ‰‡ ÒÂ ˜ÂÚÂ ”Ç‡Ì äÎÂ‚ÂÎÂÌ”

ë Û‚‡ÊÂÌËÂ: èÓÙ. çËÍÓÎ‡ äËÎËÏÓ‚

SUMMARY

ASPECTS – THE ROLE OF EARLY CT SIGNS IN PATIENTS WITH ACUTE MIDDLE CEREBRAL

ARTERY ISCHEMIC STROKE

E. Vavrek, M. KlissurskiClinic of Neurology, “Tzaritza Ioanna”

University Hospital - SofiaASPECTS is a new method with a proven efficacy for

assessment of CT changes in the early stage of the ischemicstroke.

THE AIM of this article is to introduce the protocol ofASPECTS in Bulgaria, to examine this new CT assessment ofacute stoke patients and to explore the connection betweenASPECTS and some risk factors, the effect of the treatmentand the disability on the first and third month.

CONTINGENT AND METHODS 20 patients, 15 men and5 women with mean age of 67.2 ± 7.8 years, were examined.The diagnosis was based on the clinical examination and CT.The severity of the disease was graded according to NIHSSscore. All the patients were treated with the usual treatmentwithout r-tPA. The early changes in the territory of the middlecerebral artery (MCA) were retrospectively assessed. Thepatients were classified in two groups depending of the CTresults (ASPECT below 7 and ASPECT over 6 points). Theconnection with the basic risk factors, such as arterial hyper-tension, diabetes mellitus, atrial fibrillation, changes in heartvalves, ischemic heart disease, myocardial infarction, heartfailure, smoking and some laboratory findings – serum glu-cose, CRP, creatinin, bilirubin, was studied.

RESULTS Cranial CT was performed in average time of2:04 h from the onset symptoms. The mean value of the neu-rological deficit at the admission in the patients according toNIHSS was 11.15 ± 3.8 points. 13 patients (65%) were cor-rectly assessed. The average ASPECT score of the assessedpatients was 6.61 ± 2.06 points. A connection betweenASPECTS and the risk factors was not discovered.

The average NIHSS score in the patients with ASPECTS of6 and less points was 12.2. The patients with ASPECTS over6 points had an average NIHSS score of 10.3. ModifiedRankin scale result (mRS) on the 30 day was 3.30 ± 1.8 andon the third month 2.0 ± 1.7 in the patients with ASPECTS _<6 and 1.83 ± 0.9 in the patients with ASPECTS >_ 7 points.

CONCLUSIONS The outcome of the ischemic stroke wasbetter in the patients, with higher ASPECT score, but the dis-ability on the first and third month as well as the outcomedepend not only on the early CT assessment. The assessment ofthe CT changes according to ASPECTS criteria demands a spe-cific training and expertise of the radiologists and the neurolo-gists in our country. This can help for a more precise prognosisand treatment strategy in the patient suffering ischemic stroke.

KEY WORDS: ASPECTS, CT, early ischemic stroke,thrombolysis.

êÖáûåÖ

ASPECTS Â Â‰Ì‡ ÌÓ‚‡ ÏÂÚÓ‰ËÍ‡ Ò ‰ÓÍ‡Á‡Ì‡ ÂÙÂÍÚË‚-ÌÓÒÚ Ë ËÌÙÓÏ‡ÚË‚ÌÓÒÚ Á‡ ÓˆÂÌÍ‡ Ì‡ äí ÔÓÏÂÌË ‚ ‡Ì-Ì‡Ú‡ Ù‡Á‡ Ì‡ ËÒıÂÏË˜ÌËfl ÏÓÁ˙˜ÂÌ ËÌÒÛÎÚ (àåà).

ñÖã Ì‡ Ì‡ÒÚÓfl˘‡Ú‡ ÒÚ‡ÚËfl Â ‰‡ ÒÂ ‡ÔÓ·Ë‡ ÔÓÚÓ-ÍÓÎ˙Ú ASPECTS, ‰‡ ÒÂ ÔÓÛ˜Ë ÔË ÍÓÎÍÓ ·ÓÎÌË Ô‡‚ËÎÌÓÒÂ ÓÔÂ‰ÂÎfl ÍÓÎË˜ÂÒÚ‚ÂÌËflÚ Ò·Ó ÓÚ ÚÓ˜ÍË Ë ÓÚ ‰Û„‡ÒÚ‡Ì‡ ‰‡ ÒÂ ËÁÒÎÂ‰‚‡ ‚˙ÁÍ‡Ú‡ ÏÂÊ‰Û ASPECTS ÔÓÍ‡Á‡-ÚÂÎfl Ë ÌflÍÓË ËÒÍÓ‚Ë Ù‡ÍÚÓË, ÂÙÂÍÚ‡ ÓÚ ÎÂ˜ÂÌËÂÚÓ,ËÌ‚‡ÎË‰ÌÓÒÚÚ‡ Ì‡ 3-fl ÏÂÒÂˆ Ë ËÁıÓ‰‡ ÓÚ Á‡·ÓÎfl‚‡ÌÂÚÓ.

äéçíàçÉÖçí à åÖíéÑàäà àÁÒÎÂ‰‚‡ÌË Ò‡ ÍÎËÌË˜-ÌÓ, Ô‡‡ÍÎËÌË˜ÌÓ Ë Í‡‰ËÓÎÓ„Ë˜ÌÓ 20 ·ÓÎÌË, 15 Ï˙ÊÂ Ë 5ÊÂÌË, Ì‡ ÒÂ‰Ì‡ ‚˙Á‡ÒÚ 67,2 ± 7.8 „Ó‰ËÌË Ò ıÂÏËÒÙÂË‡-ÎÂÌ àåà. ÑË‡„ÌÓÁ‡Ú‡ Â ÔÓÒÚ‡‚ÂÌ‡ ‚˙Á ÓÒÌÓ‚‡ Ì‡ ÍÎËÌË˜-ÌË Ë äí ‰‡ÌÌË, Í‡ÚÓ ÚÂÊÂÒÚÚ‡ Ì‡ ËÌÒÛÎÚ‡ Â ÓÔÂ‰ÂÎÂÌ‡ÒÔÓÂ‰ ÚÓ˜ÍÓ‚Ëfl ÂÁÛÎÚ‡Ú ÓÚ NIHSS. èË ‚ÒË˜ÍË ·ÓÎÌËÂ Á‡ÔÓ˜Ì‡ÚÓ ÒÚ‡Ì‰‡ÚÌÓ ÎÂ˜ÂÌËÂ ‰Ó 3-fl ˜‡Ò ÓÚ Ì‡˜‡ÎÓÚÓÌ‡ ÒËÏÔÚÓÏ‡ÚËÍ‡Ú‡. êÂÚÓÒÔÂÍÚË‚ÌÓ Ò‡ ÓˆÂÌfl‚‡ÌË‡ÌÌËÚÂ ÔÓÏÂÌË ‚ ÏÓÁ˙˜ÌËfl Ô‡ÂÌıËÏ ‚ ÚÂËÚÓËflÚ‡Ì‡ ëåÄ ÒÔÓÂ‰ ASPECTS ÔÓÚÓÍÓÎ‡ ÔË ÚÓ˜ÍÓ‚‡ ÒÍ‡Î‡ÓÚ 0 ‰Ó 10 ÚÓ˜ÍË, Í‡ÚÓ ÓˆÂÌËÚÂÎËÚÂ ÌÂ ·flı‡ Á‡ÔÓÁÌ‡ÚËÒ ÍÎËÌË˜ÌËÚÂ ‰‡ÌÌË Ì‡ ·ÓÎÌËÚÂ. è‡ˆËÂÌÚËÚÂ Ò‡ ‡ÁÔÂ-‰ÂÎÂÌË ‚ ‰‚Â „ÛÔË ‚ Á‡‚ËÒËÏÓÒÚ ÓÚ äí Ì‡ıÓ‰Í‡(ASPECTS ÔÓ‰ 7 Ú. Ë ASPECTS Ì‡‰ 6 Ú.), Í‡ÚÓ Ò‡ ÔÓÛ-˜ÂÌ‡ ‚˙ÁÍ‡Ú‡ Ò ÓÒÌÓ‚ÌËÚÂ ËÒÍÓ‚Ë Ù‡ÍÚÓË – ‡ÚÂË-‡ÎÌ‡ ıËÔÂÚÓÌËfl, Á‡ı‡ÂÌ ‰Ë‡·ÂÚ, ‡·ÒÓÎ˛ÚÌ‡ ‡ËÚÏËfl,ÍÎ‡ÔÌË ÔÓÏÂÌË, ÏËÓÍ‡‰ÂÌ ËÌÙ‡ÍÚ, ËÒıÂÏË˜Ì‡ ·ÓÎÂÒÚÌ‡ Ò˙ˆÂÚÓ, Ò˙‰Â˜Ì‡ ÌÂ‰ÓÒÚ‡Ú˙˜ÌÓÒÚ, Ú˛Ú˛ÌÓÔÛ¯ÂÌÂË ÌflÍÓË Î‡·Ó‡ÚÓÌË ÔÓÍ‡Á‡ÚÂÎË – Í˙‚Ì‡ Á‡ı‡, CRP,ÍÂ‡ÚËÌËÌ, ·ËÎËÛ·ËÌ, Ú‡ÌÒ‡ÏËÌ‡ÁË Ë ‰.

êÖáìãíÄíà äí Â ÔÓ‚Â‰ÂÌ‡ Á‡ ÒÂ‰ÌÓ ‚ÂÏÂ 2:04 ˜‡ÒÓÚ Ì‡˜‡ÎÓÚÓ Ì‡ ÒËÏÔÚÓÏËÚÂ. ëÂ‰Ì‡Ú‡ ÓˆÂÌÍ‡ Ì‡ ÌÂ‚-ÓÎÓ„Ë˜ÌËfl ‰ÂÙËˆËÚ ÔË ÔÓÒÚ˙Ô‚‡ÌÂÚÓ Ì‡ ·ÓÎÌËÚÂ Òàåà ÒÔÓÂ‰ NIHSS Â 11.15 ±3.8. è‡‚ËÎÌÓ ÓˆÂÌÂÌË Ò‡ 13·ÓÎÌË (65%). ëÂ‰ÌËflÚ ASPECTS Ò·Ó Ì‡ ÓˆÂÌfl‚‡ÌËÚÂ·ÓÎÌË Â ·ËÎ 6,61 ± 2.06. Ç˙ÁÍ‡ ÏÂÊ‰Û ASPECTS Ò·Ó‡ ËËÒÍÓ‚ËÚÂ Ù‡ÍÚÓË ÌÂ ·Â¯Â ÓÚÍËÚ‡.

èË 13 Ô‡ˆËÂÌÚË ÒÂ ÓÚÍËı‡ äí ·ÂÎÂÁË ÓÚ„Ó‚‡fl˘Ë Ì‡Ì‡ÒÚÓfl˘Ëfl ËÌˆË‰ÂÌÚ. ëÂ‰ÌËflÚ NIHSS Ò·Ó ÔË ·ÓÎÌË-ÚÂ Ò ASPECTS Ò 6 ËÎË ÔÓ-Ï‡ÎÍÓ ÚÓ˜ÍË Â ·ËÎ 12,2. èË·ÓÎÌËÚÂ Ò ASPECTS Ì‡‰ 6 Ú. NIHSS Â ·ËÎ ÒÂ‰ÌÓ 10.3.mRS Ì‡ 30-fl ‰ÂÌ Â ·ËÎ 3.30 ± 1,8, ‡ Ì‡ 90-fl ‰ÂÌ Â ·ËÎ 2.0 ±1.7 ÔË ·ÓÎÌËÚÂ Ò ASPECTS _< 6 Ú. mRS ÔË ÚÂÁË ÒASPECTS >_ 7 Ú. Â ·ËÎ 1,83 ± 0.9.

àáÇéÑà àÁıÓ‰˙Ú ÒÂ‰ àåà Â ·ËÎ ÔÓ-‰Ó·˙ ÔË ·ÓÎÌËÚÂÒ ÔÓ-„ÓÎflÏ ASPECTS Ò·Ó, ÌÓ ËÌ‚‡ÎË‰ÌÓÒÚÚ‡ Ì‡ 1-fl Ë 3-fl ÏÂÒÂˆ Ë ËÁıÓ‰‡ ÓÚ Á‡·ÓÎfl‚‡ÌÂÚÓ ÌÂ Á‡‚ËÒflÚ Ò‡ÏÓ ÓÚ‡ÌÌ‡Ú‡ äí ÓˆÂÌÍ‡. éˆÂÌfl‚‡ÌÂÚÓ Ì‡ äí ÔÓÏÂÌËÚÂ ÒÔÓÂ‰ASPECTS ËÁËÒÍ‚‡ ÒÔÂˆËÙË˜ÌÓ Ó·Û˜ÂÌËÂ Ë ÂÍÒÔÂÚËÁ‡ ÓÚÒÚ‡Ì‡ Ì‡ ÂÌÚ„ÂÌÓÎÓÁË Ë ÌÂ‚ÓÎÓÁË ‚ Ì‡¯‡Ú‡ ÒÚ‡Ì‡, Í‡ÚÓÚÓÁË Ì‡˜ËÌ ÔÓ-ÔÂˆËÁÌÓ ÏÓÊÂ ‰‡ ÒÂ ‰ÂÙËÌË‡ ÔÓ„ÌÓÁ‡Ú‡ ÔËÔÓ‰„ÛÔËÚÂ ·ÓÎÌË Ò àåà Ë ÚÂ‡ÔÂ‚ÚË˜Ì‡Ú‡ ÒÚ‡ÚÂ„Ëfl.

äãûóéÇà Ñìåà: ASPECTS, ÓÒÚ˙ ËÒıÂÏË˜ÂÌ ÏÓÁ˙-˜ÂÌ ËÌÒÛÎÚ, KT, ÚÓÏ·ÓÎËÁ‡.


éË„ËÌ‡ÎÌË ÒÚ‡ÚËËASPECTS - áçÄóÖçàÖ çÄ êÄççàíÖ äí ÅÖãÖáà èêà Åéãçà

ë àëïÖåàóÖç åéáöóÖç àçëìãí Ç ÅÄëÖâçÄ çÄ ëêÖÑçÄ åéáöóçÄ ÄêíÖêàü

Ö. Ç‡‚ÂÍ, å. äÎËÒÛÒÍË

ä‡ÚÂ‰‡ ÔÓ ÌÂ‚ÓÎÓ„Ëfl, åì - ëÓÙËflåÅÄã “ñ‡Ëˆ‡ âÓ‡ÌÌ‡” – ëÓÙËfl, äÎËÌËÍ‡ ÔÓ ÌÂ‚ÓÎÓ„Ëfl

Ç˙ÁÏÓÊÌÓÒÚÚ‡ Á‡ ÔÓ‚ÂÊ‰‡ÌÂ Ì‡ ÚÓÏ·ÓÎËÚË˜Ì‡ ÚÂ-‡ÔËfl (íã) ‚ Ì‡È-‡ÌÌ‡ Ù‡Á‡ Ì‡ ËÒıÂÏË˜ÌËfl ÏÓÁ˙˜ÂÌ ËÌ-ÒÛÎÚ (àåà) Ë ÌÂÈÌ‡Ú‡ ÂÙÂÍÚË‚ÌÓÒÚ ÔÂ‰ËÁ‚ËÍ‡ı‡ ÔÂ-‡Á„ÎÂÊ‰‡ÌÂ Ì‡ ÚÂ‡ÔÂ‚ÚË˜ÌËÚÂ Ë ‰Ë‡„ÌÓÒÚË˜ÌË ÔÓÚÓ-ÍÓÎË (1,3,4,11,12,15,16). Ö‰ËÌ ÓÚ ÌÂ·Î‡„ÓÔËflÚÌËÚÂ ÍË-ÚÂËË Á‡ ÛÒÔÂ¯Ì‡ íã Â Ì‡ÎË˜ËÂÚÓ Ì‡ ıËÔÓ‰ÂÌÁÌ‡ ËÒıÂÏË˜-Ì‡ ÁÓÌ‡, ÔÓ-„ÓÎflÏ‡ ÓÚ 1/3 ÓÚ ÚÂËÚÓËflÚ‡ Ì‡ ëåÄ, ÔËÔ˙‚ÓÌ‡˜‡ÎÌÓÚÓ äí ËÁÒÎÂ‰‚‡ÌÂ (8,10). éÍ‡Á‡ ÒÂ, ˜Â Ô‡‚Ë-ÎÓÚÓ Á‡ Û‚Â‰‡ ÔÓ-„ÓÎflÏ‡ ÓÚ Â‰Ì‡ ÚÂÚ‡ ÓÚ ëåÄ Â ÌÂ-ÒË„ÛÂÌ ÍÎËÌË˜ÂÌ ·ÂÎÂ„ Ë ÔÓ-ÒÎ‡·Ó ‰ÂÙËÌË‡Ì Ó·ÂÏÂÌ ÔÓ-Í‡Á‡ÚÂÎ Á‡ ‡ÁÏÂ‡ Ì‡ ‡ÌÌ‡Ú‡ ÏÓÁ˙˜Ì‡ Û‚Â‰‡. Ö‰Ì‡ ÌÓ-‚‡ ÏÂÚÓ‰ËÍ‡ Ò ‰ÓÍ‡Á‡Ì‡ ÂÙÂÍÚË‚ÌÓÒÚ Ë ËÌÙÓÏ‡ÚË‚-ÌÓÒÚ, ÍÓflÚÓ ÔÓÌ‡ÒÚÓfl˘ÂÏ ˜ÂÒÚÓ ÒÂ ËÁÔÓÎÁ‚‡ Á‡ ÓˆÂÌÍ‡Ì‡ äí ÔÓÏÂÌËÚÂ ‚ ‡ÌÌ‡Ú‡ Ù‡Á‡ Ì‡ àåà Â ASPECTS(1,3,7,9). éˆÂÌfl‚‡ÌÂÚÓ Ì‡ äí ÔÓÏÂÌËÚÂ ÒÔÓÂ‰ASPECTS ËÁËÒÍ‚‡ ÒÔÂˆËÙË˜ÌÓ Ó·Û˜ÂÌËÂ Ë ÂÍÒÔÂÚËÁ‡(1,16,17), ÌÓ ÔÓ ÚÓÁË Ì‡˜ËÌ ÒÂ ‰ÂÙËÌË‡Ú ÔÓ-ÔÂˆËÁÌÓÔÓ‰„ÛÔËÚÂ ·ÓÎÌË, ÚÂ‡ÔÂ‚ÚË˜Ì‡Ú‡ ÒÚ‡ÚÂ„Ëfl Ë ËÁıÓ‰‡ÓÚ Á‡·ÓÎfl‚‡ÌÂÚÓ (6).

ñÂÎ Ì‡ Ì‡ÒÚÓfl˘‡Ú‡ ÒÚ‡ÚËfl Â ‰‡ ÒÂ ‡ÔÓ·Ë‡ ÔÓÚÓ-ÍÓÎ˙Ú ASPECTS. éÚ Â‰Ì‡ ÒÚ‡Ì‡ ‰‡ ÒÂ ÔÓÛ˜Ë ÒÔÂˆËÙË˜-ÌÓÒÚÚ‡ ÔË ÓÔÂ‰ÂÎflÌÂ Ì‡ ÍÓÎË˜ÂÒÚ‚ÂÌËfl Ò·Ó ÓÚ ÚÓ˜-ÍË Ë ÓÚ ‰Û„‡ ÒÚ‡Ì‡ ‰‡ ÒÂ ËÁÒÎÂ‰‚‡ ‚˙ÁÍ‡Ú‡ ÏÂÊ‰ÛASPECTS ÔÓÍ‡Á‡ÚÂÎfl Ë ÌflÍÓË ËÒÍÓ‚Ë Ù‡ÍÚÓË, ÂÙÂÍÚ‡ÓÚ ÎÂ˜ÂÌËÂÚÓ, ËÌ‚‡ÎË‰ÌÓÒÚÚ‡ Ì‡ 1-fl Ë 3-fl ÏÂÒÂˆ Ë ËÁıÓ-‰‡ ÓÚ Á‡·ÓÎfl‚‡ÌÂÚÓ ÔË 20 ·ÓÎÌË Ò ÓÒÚ˙ ıÂÏËÒÙÂË‡ÎÂÌàåà ‰Ó 3-fl ˜‡Ò.

äéçíàçÉÖçí à åÖíéÑàäà

Ç ‡ÏÍËÚÂ Ì‡ Ì‡ÒÚÓfl˘ÓÚÓ ÔÓÛ˜‚‡ÌÂ Ò‡ ËÁÒÎÂ‰‚‡ÌËÓ·˘Ó 20 Ô‡ˆËÂÌÚË Ò ÓÒÚ˙ ıÂÏËÒÙÂË‡ÎÂÌ àåà, 15 Ï˙-ÊÂ Ë 5 ÊÂÌË, Ì‡ ‚˙Á‡ÒÚ ÓÚ 53 ‰Ó 82 „., Ì‡ ÒÂ‰Ì‡ ‚˙Á‡ÒÚ67,2 ±7,8 „, ÎÂÍÛ‚‡ÌË ‚ ÍÎËÌËÍ‡Ú‡ ÔÓ ÌÂ‚ÓÎÓ„Ëfl Ì‡ åÅÄã◊ñ‡Ëˆ‡ âÓ‡ÌÌ‡” – ëÓÙËfl Á‡ ÔÂËÓ‰‡ 2004-2006 „.

ÅÓÎÌËÚÂ Ò‡ ËÁÒÎÂ‰‚‡ÌË Ô‡‡ÍÎËÌË˜ÌÓ Ë Í‡‰ËÓÎÓ„Ë˜ÌÓ,Í‡ÚÓ ÍÓÎË˜ÂÒÚ‚ÂÌ‡Ú‡ ÓˆÂÌÍ‡ Ì‡ ÌÂ‚ÓÎÓ„Ë˜ÌËfl ‰ÂÙËˆËÚÂ Ì‡Ô‡‚ÂÌ‡ ÒÔÓÂ‰ ÍËÚÂËËÚÂ Ì‡ ÒÍ‡Î‡Ú‡ NIHSS, ËÌ‚‡-ÎË‰ÌÓÒÚÚ‡ ÒÔÓÂ‰ ÏÓ‰ËÙËˆË‡Ì‡Ú‡ ÒÍ‡Î‡ Ì‡ ê‡ÌÍËÌ –mRS. éÚ ËÁÒÎÂ‰‚‡ÌÂÚÓ Ò‡ ËÁÍÎ˛˜ÂÌË ·ÓÎÌËÚÂ Ò ÎÂÍËÒËÏÔÚÓÏË (NIHSS ÔÓ‰ 6) Ë ÚÂÁË Ò Ì‡Û¯ÂÌËfl Ì‡ Ò˙ÁÌ‡ÌË-ÂÚÓ, ÔÓ-ÚÂÊÍË ÓÚ ÒÓÏÌÓÎÂÌÚÌÓÒÚ. ç‡Ô‡‚ÂÌ‡ Â ÓˆÂÌÍ‡Ì‡ ‚˙ÁÍ‡Ú‡ ÏÂÊ‰Û Ì‡˜‡ÎÌËfl ASPECTS Ò·Ó Ë ÂÁÛÎÚ‡Ú‡ÓÚ ËÌ‚‡ÎË‰ÌÓÒÚÚ‡ ÒÔÓÂ‰ mRS Ì‡ 1-fl Ë 3-fl ÏÂÒÂˆ.

è‡ˆËÂÌÚËÚÂ Ò‡ ÔÓ‚ÂÊ‰‡ÎË ÒÚ‡Ì‰‡ÚÌÓ ÎÂ˜ÂÌËÂ Á‡àåà ÔËÂÚÓ ‚ Ì‡¯‡Ú‡ ÍÎËÌËÍ‡, ‚ÍÎ˛˜ËÚÂÎÌÓ Ò ‡ÒÔËËÌ,ÌÂ‚ÓÔÓÚÂÍÚÓ Ë ÍÓÌÚÓÎ ‚˙ıÛ ËÒÍÓ‚ËÚÂ Ù‡ÍÚÓË.è‡ˆËÂÌÚËÚÂ Ò‡ ‡ÁÔÂ‰ÂÎÂÌË ‚ ‰‚Â „ÛÔË ‚ Á‡‚ËÒËÏÓÒÚÓÚ äí Ì‡ıÓ‰Í‡. è˙‚‡ „ÛÔ‡ Ò ASPECTS ÔÓ‰ 7 Ú. Ë ‚ÚÓ-‡ „ÛÔ‡ Ò ASPECTS Ì‡‰ 6 Ú. èÓÛ˜ÂÌ‡ Â ‚˙ÁÍ‡Ú‡ Ì‡ASPECTS Ò ÓÒÌÓ‚ÌËÚÂ ËÒÍÓ‚Ë Ù‡ÍÚÓË – ‡ÚÂË‡ÎÌ‡ıËÔÂÚÓÌËfl, Á‡ı‡ÂÌ ‰Ë‡·ÂÚ, ‡·ÒÓÎ˛ÚÌ‡ ‡ËÚÏËfl, ÍÎ‡Ô-Ì‡ Ô‡ÚÓÎÓ„Ëfl, ÏËÓÍ‡‰ÂÌ ËÌÙ‡ÍÚ, ËÒıÂÏË˜Ì‡ ·ÓÎÂÒÚ Ì‡Ò˙ˆÂÚÓ, Ò˙‰Â˜Ì‡ ÌÂ‰ÓÒÚ‡Ú˙˜ÌÓÒÚ, Ú˛Ú˛ÌÓÔÛ¯ÂÌÂ ËÌflÍÓË Î‡·Ó‡ÚÓÌË ÔÓÍ‡Á‡ÚÂÎË – Í˙‚Ì‡ Á‡ı‡, CRP, ÍÂ-‡ÚËÌËÌ, ·ËÎËÛ·ËÌ, Ú‡ÌÒ‡ÏËÌ‡ÁË Ë ‰.

á‡ ÔÓ‚ÂÊ‰‡ÌÂ Ì‡ ÍÓÏÔ˛Ú˙Ì‡ ÚÓÏÓ„‡ÙËfl Ì‡ ÏÓÁ˙Í‡Â ËÁÔÓÎÁ‚‡Ì ‡Ô‡‡Ú ÑÊÂÌÂ‡Î ÖÎÂÍÚËÍ, ÏÓ‰ÂÎ MAK-640. ASPECTS ‡Á˜ËÚ‡ÌËflÚ‡ Ì‡ ÒÌËÏÍËÚÂ Ò‡ Ì‡Ô‡‚ÂÌËÂÚÓÒÔÂÍÚË‚ÌÓ ÓÚ ‰‚‡Ï‡Ú‡ ‡‚ÚÓË, ÌÂÁ‡‚ËÒËÏÓ ÓÚ‰‡ÌÌËÚÂ Ì‡ ÍÎËÌË˜ÌÓÚÓ ËÁÒÎÂ‰‚‡ÌÂ, Ï‡Í‡ ˜Â ‚ ÔÓÒÎÂ‰ÌÓ‚ÂÏÂ ÒÂ ÔÂÔÓ˙˜‚‡, ‡Á˜ËÚ‡˘ËflÚ äí ‰‡ÌÌË ‰‡ Â Á‡ÔÓÁ-Ì‡Ú Ò˙Ò ÒÚ‡Ì‡Ú‡ Ì‡ ÏÓÁ˙˜ÌËfl ËÌÒÛÎÚ (1, 3, 18). (îË„Û‡1). éˆÂÌÍ‡Ú‡ Â ËÁ‚˙¯‚‡Ì‡ ÒÔÓÂ‰ ÚÓ˜ÍÓ‚‡ ÒÍ‡Î‡ ÓÚ 0 ‰Ó10 Ú. èË ÌÓÏ‡ÎÂÌ, ÌÂÔÓÏÂÌÂÌ äí Ó·‡Á Ì‡ ÒÚÛÍÚÛË-ÚÂ ‚ ·‡ÒÂÈÌ‡ Ì‡ ëåÄ ÒÂ Á‡‰‡‚‡Ú 10 Ú. ÄÌ‡ÎËÁË‡ÌË Ò‡‰‚‡ ÒÂÁ‡ ÔÂÁ ‰ÓÎÌ‡Ú‡ Ë „ÓÌ‡ ÏÂ‡ÚÓ-Ó·ËÚ‡ÎÌ‡ ÎËÌËfl

(åéã) – Ô˙‚‡Ú‡ Ì‡ ÌË‚ÓÚÓ Ì‡ ·‡Á‡ÎÌËÚÂ „‡Ì„ÎËË Ë Ú‡-Î‡ÏÛÒ‡ Ë ‚ÚÓ‡Ú‡ ÌÂÔÓÒÂ‰ÒÚ‚ÂÌÓ Ì‡‰ „ÓÌ‡Ú‡ „‡ÌËˆ‡Ì‡ ·‡Á‡ÎÌËÚÂ fl‰‡. ë˙ÓÚ‚ÂÚÌÓ ‚ÒflÍ‡ ÓÚ 10-ÚÂ ÁÓÌË Ì‡ëåÄ – ÙÓÌÚ‡ÎÌ‡ (å1, å4), Ô‡ËÂÚ‡ÎÌ‡ (å2, å5) ËÚÂÏÔÓ‡ÎÌ‡ Ó·Î‡ÒÚ (å3, å6), ÌÛÍÎÂÛÒ ÎÂÌÚËÙÓÏËÒ(çã), ÌÛÍÎÂÛÒ Í‡Û‰‡ÚÛÒ (çä), Í‡ÔÒÛÎ‡ ËÌÚÂÌ‡ (äà), ËÌ-ÒÛÎ‡Ì‡Ú‡ „˙ÌÍ‡ /Ô‡Ì‰ÂÎÍ‡ (àÉ) - ÌÓÒË ÔÓ Â‰Ì‡ ÚÓ˜Í‡, Í‡Í-ÚÓ Â ÔÂ‰ÒÚ‡‚ÂÌÓ Ì‡ îË„Û‡ 1. èË àåà ÒÂ ÓÚÌÂÏ‡ ÔÓÂ‰Ì‡ ÚÓ˜Í‡ Á‡ ‚ÒflÍ‡ ÓÚ ÚÂÁË ÁÓÌË, ‚ ÍÓflÚÓ ÒÂ ÛÒÚ‡ÌÓ‚fl-‚‡Ú ‡ÌÌË äí ·ÂÎÂÁË Á‡ ÏÓÁ˙˜Ì‡ ËÒıÂÏËfl ËÎË ÍÓÏ·ËÌ‡ˆËflÓÚ ·ÂÎÂÁË Ì‡ Û‚Â‰‡, Í‡ÚÓ ÎÓÍ‡ÎÂÌ ÓÚÓÍ, Ì‡Ï‡ÎÂÌËÂ Ì‡ÔÎ˙ÚÌÓÒÚÚ‡ (ıËÔÓ‰ÂÌÁÌ‡ ÁÓÌ‡), ËÁ„Î‡Ê‰‡ÌÂ Ì‡ „˙ÌÍËÚÂ,◊Ï‡Ò-ÂÙÂÍÚ” Ò ÍÓÏÔÂÒËfl Ì‡ ‚ÂÌÚËÍÛÎË, ·‡Á‰Ë ËÎË „˙Ì-ÍË, Á‡ÎË˜‡‚‡ÌÂ Ì‡ „‡ÌËˆ‡Ú‡ ÏÂÊ‰Û ·flÎÓ Ë ÒË‚Ó ‚Â˘ÂÒÚ-‚Ó Ë ‰. (1,3,4,6,7). ë·Ó ÌÛÎ‡ ÒÂ ‰ÂÙËÌË‡ ÔË ÚÓÚ‡ÎÂÌÚÂËÚÓË‡ÎÂÌ ËÌÙ‡ÍÚ Ì‡ ëåÄ.

èË Ô‡ˆËÂÌÚËÚÂ ‰ÓÔ˙ÎÌËÚÂÎÌÓ Â ÔÓ‚ÂÊ‰‡Ì‡ Ë ÒÚ‡Ì-‰‡ÚÌ‡ ÂÍÒÚ‡- Ë Ú‡ÌÒÍ‡ÌË‡ÎÌ‡ ÑëÉ Ò ‡Ô‡‡ÚExplorer CVS.

êÖáìãíÄíà

êàëäéÇà îÄäíéêà

éÚ ËÁ‚ÂÒÚÌËÚÂ ËÒÍÓ‚Ë Ù‡ÍÚÓË ÒÂ ÓÚÍË‚‡Ú Ì‡È-˜ÂÒÚÓ ‡ÚÂË‡ÎÌ‡ ıËÔÂÚÓÌËfl (18/20), Ú˛Ú˛ÌÓÔÛ¯ÂÌÂ(6/7), ‡ËÚÏËË (9/20), àÅë (13/20).

àÁÒÎÂ‰‚‡ÈÍË ËÒÍÓ‚ËÚÂ Ù‡ÍÚÓË Á‡ ÚÓÏ·ÓÚË˜ÂÌ ËÂÏ·ÓÎË˜ÂÌ àåà, Ò‡ÏÓÒÚÓflÚÂÎÌÓ ËÎË „ÛÔË‡ÌË, ÌÂ ÛÒ-Ú‡ÌÓ‚ËıÏÂ ‚˙ÁÍ‡ Ò ÚÂÊÂÒÚÚ‡ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ, ÓˆÂÌÍ‡-Ú‡ ÔÓ ASPECTS Ë Ò ÔÓ„ÌÓÁ‡Ú‡.

äí àáëãÖÑÇÄçÖ

éÚ ‡Á„ÎÂ‰‡ÌËÚÂ 20 ÒÍÂÌÂ„‡ÏË ÔË 18 (85.7%) ·ÓÎÌËÓÔÂ‰ÂÎËıÏÂ ASPECTS Ò·Ó‡ ‚ Ò˙ÓÚ‚ÂÚÒÚ‚ËÂ Ò ÎËÚÂ‡-ÚÛÌËÚÂ ‰‡ÌÌË, ‡ ÔË 2 ÌÂ ÛÒÔflıÏÂ. éÚ 18-ÚÂ ·ÓÎÌË, ÔË13 äí ·ÂÎÂÁËÚÂ ÍÓÂÒÔÓÌ‰Ë‡Ú Ò˙Ò ÒÚ‡Ì‡Ú‡ Ì‡ ËÌÒÛÎ-Ú‡, ‡ ÔË 5 ÌflÏ‡ ÍÓÂÎ‡ˆËfl Ò˙Ò ÒÚ‡Ì‡Ú‡. ëÂ‰ÌËflÚASPECTS Ò·Ó ÔË ÓˆÂÌÂÌËÚÂ 18 ·ÓÎÌË Â 6,61±2.06 (‰Ë‡-Ô‡ÁÓÌ 2 - 9 Ú.).

èË 5 ·ÓÎÌË (27,8%) ÌÂ ÒÂ ÓÚÍËı‡ äí ‰‡ÌÌË, ÍÓÂÒ-ÔÓÌ‰Ë‡˘Ë Ò Ì‡ÒÚÓfl˘Ëfl ËÌˆË‰ÂÌÚ, Í‡ÚÓ ÚËÏ‡ ÓÚ ÚÂ-ÁË Ô‡ˆËÂÌÚË Ò‡ ÒÍÂÌË‡ÌË Ì‡ 1:30-1:35 ˜‡Ò‡ ÓÚ Ì‡˜‡ÎÓÚÓÌ‡ ËÌˆË‰ÂÌÚ‡, ‡ ÔË ‰Û„ËÚÂ ‰‚‡Ï‡ ÓÚ Úflı ËÏ‡ ‰‡ÌÌË Á‡ÏÛÎÚËËÌÙ‡ÍÚÌ‡ ÂÌˆÂÙ‡ÎÓÔ‡ÚËfl.

èË Â‰ËÌ ·ÓÎÂÌ Ò‡ ÓÚÍËÚË Ì‡È-ËÁ‡ÁÂÌË äí ÔÓÏÂÌË- ASPECTS ÂÁÛÎÚ‡Ú ÓÚ 2 ÚÓ˜ÍË, ÔÓ‡‰Ë Ï‡ÎË„ÌÂÌ ËÌ-Ù‡ÍÚ Ì‡ ëåÄ.

èË ÚËÏ‡ ·ÓÎÌË Â ÔÓ‚Â‰ÂÌÓ ÔÓ‚ÚÓÌÓ äí ËÁÒÎÂ‰‚‡-ÌÂ, Í‡ÚÓ ÔÓÏÂÌËÚÂ, ‚˙Á ÓÒÌÓ‚‡ Ì‡ ÍÓËÚÓ ·Â¯Â Ì‡Ô‡‚Â-Ì‡ ÓˆÂÌÍ‡Ú‡ ÔÓ ASPECTS ÍÓÂÒÔÓÌ‰Ë‡ı‡ Ò „ÓÎÂÏËÌ‡Ú‡Ì‡ ‰ÂÏ‡ÍË‡Ì‡Ú‡ ÔË ‚ÚÓÓÚÓ ÒÍÂÌË‡ÌÂ ÁÓÌ‡.

NIHSS: ëÂ‰Ì‡Ú‡ ÒÚÂÔÂÌ Ì‡ ÌÂ‚ÓÎÓ„Ë˜ÂÌ ‰ÂÙËˆËÚÔË Ì‡˜‡ÎÓÚÓ Ì‡ àåà ÒÔÓÂ‰ ÒÍ‡Î‡Ú‡ Ì‡ ÓˆÂÌÍ‡ NIHSSÂ 11.15 ± 3.8.

ÄÌ‡ÎËÁË‡ÈÍË ‚˙ÁÍ‡Ú‡ ÏÂÊ‰Û Ì‡˜‡ÎÌ‡Ú‡ ÒËÏÔÚÓÏ‡-ÚËÍ‡, ËÁ‡ÁÂÌ‡ ˜ÂÁ ÓˆÂÌÍ‡ ÔÓ NIHSS Ë ‡ÌÌËÚÂ äí ÔÓ-ÏÂÌË, ÓÚ‡ÁÂÌË ˜ÂÁ ASPECTS Ò·Ó‡, ÒÂ ÓÚÍË‚‡ ÒÎÂ‰Ì‡-Ú‡ ‚˙ÁÍ‡. èË ·ÓÎÌËÚÂ ÓÚ Ô˙‚‡Ú‡ „ÛÔ‡ Ò ÔÓ-ËÁ‡ÁÂÌËäí ÔÓÏÂÌË (ASPECTS ÔÓ‰ 7) ÂÁÛÎÚ‡Ú˙Ú Á‡ NIHSS ÔËÔÓÒÚ˙Ô‚‡ÌÂÚÓ ‚ ÍÎËÌËÍ‡Ú‡ Â ·ËÎ ÓÚ 6 ‰Ó 18 Ú, ÒÂ‰ÌÓ12.2. èË ‚ÚÓ‡Ú‡ „ÛÔ‡ ·ÓÎÌË (ASPECTS Ì‡‰ 6 Ú.)NIHSS Â ·ËÎ ÓÚ 6 ‰Ó 14 ÚÓ˜ÍË, ÒÂ‰ÌÓ 10.3.

mRS: ëÂ‰Ì‡Ú‡ ÓˆÂÌÍ‡ ÔÓ mRS Ì‡ 30-fl ‰ÂÌ ÔË ‚ÒË˜ÍË·ÓÎÌË Â 3.30 ±1.8. ç‡ 90-fl ‰ÂÌ ·ÓÎÌËÚÂ (n=3) Ò ÔÓ-ËÁ‡ÁÂÌËäí ÔÓÏÂÌË (ASPECTS <_ 7 Ú.) ËÏ‡Ú ÒÂ‰Ì‡ ÓˆÂÌÍ‡ ÔÓmRS 2,0 ± 1.7, ÍÓflÚÓ Â ÔÓ-‚ËÒÓÍ‡ ÓÚ Ò˙ÓÚ‚ÂÚÌ‡Ú‡ ÒÂ‰-


Ì‡ ÓˆÂÌÍ‡ mRS 1,83 ± 0.9 ÔË ÚÂÁË (n=6) Ò ÔÓ-Ï‡ÎÍÓ Ì‡˜‡Î-ÌË äí ÔÓÏÂÌË (ASPECTS _>7 Ú.). äÓ„‡ÚÓ ÒÂ ËÁÔÓÎÁ‚‡ „‡-ÌËˆ‡ Á‡ ‰ËÙÂÂÌˆË‡ÌÂ Ì‡ ·ÓÎÌËÚÂ ÒÔÓÂ‰ ASPECTS <_ 7 Ú.Ë Ò˙ÓÚ‚ÂÚÌÓ _> 8 Ú., ÒÚÓÈÌÓÒÚËÚÂ Ì‡ mRS Ì‡ 90-fl ‰ÂÌ Ò‡‰ÓË ÔÓ-ËÁ‡ÁÂÌË - 2,2 ±1.3 ÒÂ˘Û 1,5 ± 1.0. éÚ ÓˆÂÌfl‚‡ÌÂ-ÚÓ Ò‡ ËÁÍÎ˛˜ÂÌË ÔÓ˜ËÌ‡ÎËÚÂ Ô‡ˆËÂÌÚË. Ç ÒÎÛ˜‡È, ˜Â ÔÓ˜Ë-Ì‡ÎËÚÂ ÒÂ ÓˆÂÌflÚ Ò 6 ÔÓ mRS ÒÂ ÔÓÎÛ˜‡‚‡Ú ÂÁÛÎÚ‡ÚË 4Í˙Ï 2.43 ÔË „‡ÌËˆ‡ 6/7 Ë 3.63 Í˙Ï 2.4 ÔË „‡ÌËˆ‡ 7/8.

ÑëÉ ËÁÒÎÂ‰‚‡ÌÂ ‰ÂÏÓÌÒÚË‡ ÁÌ‡˜ËÏË ÔÓÏÂÌË ‚ Í˙-‚ÓÚÓÍ‡ Ì‡ BCA Ë CMA ÔË 7 ÓÚ 8 ·ÓÎÌË Ò (ASPECTS <_ 7Ú.) Ë Ò‡ÏÓ ÔË Â‰ËÌ ÓÚ ‰ÂÒÂÚÚÂ ·ÓÎÌË ‚ „ÛÔ‡Ú‡ Ò(ASPECTS Ì‡‰ 6 Ú.)

è‡‡ÍÎËÌË˜ÌË ËÁÒÎÂ‰‚‡ÌËfl ÌÂ ÔÓÍ‡Á‡ı‡ ÁÌ‡˜ËÏËÚÂÌ‰ÂÌˆËË Á‡ ÔÓÏÂÌË. ASAT Ë ALAT ÒÂ ÓÚÍËı‡ Û‚ÂÎË-˜ÂÌË Â‰ËÌÒÚ‚ÂÌÓ ÔË Â‰ËÌ Ô‡ˆËÂÌÚ – Ò ‰‡ÌÌË Á‡ í-ÓÍÎÛÁËflË Ï‡ÎË„ÌÂÌ ËÌÙ‡ÍÚ, ÓˆÂÌÂÌ ÔÓ ASPECT Ò 2 ÚÓ˜ÍË, ‚ÔÓÒ-ÎÂ‰ÒÚ‚ËÂ ÔÓ˜ËÌ‡Î. èË Ò˙˘Ëfl Ô‡ˆËÂÌÚ ÒÂ ÓÚÍË‚‡Ú 3ËÒÍÓ‚Ë Ù‡ÍÚÓ‡, Û‚ÂÎË˜ÂÌ CRP Ë ÎÂÍ‡ ıËÔÂ„ÎËÍÂÏËfl(6.8 ÏÏÓÎ/Î). 15 Ô‡ˆËÂÌÚË Ò‡ Ò ÎÂÍÓ ÔÓ‚Ë¯ÂÌË Ì‡˜‡ÎÌËÒÚÓÈÌÓÒÚË Ì‡ Í˙‚Ì‡Ú‡ „Î˛ÍÓÁ‡, Í‡ÚÓ ÌÂ ÒÂ ÓÚÍË‚‡ Á‡-‚ËÒËÏÓÒÚ ÏÂÊ‰Û ÚÂÁË ÒÚÓÈÌÓÒÚË, ÚÂÊÂÒÚÚ‡ Ì‡ ÍÎË-ÌË˜Ì‡Ú‡ Í‡ÚËÌ‡, ÚÓ˜ÍËÚÂ ÔÓ ASPECT Ë ÔÓ„ÌÓÁ‡Ú‡.Ñ‚‡Ï‡ Ò‡ Ò˙Ò ÒÚÓÈÌÓÒÚË Ì‡ äá Ì‡‰ 10, Í‡ÚÓ ÚÂ Ò‡ Ò ÚÂÊ-Í‡ Ì‡˜‡ÎÌ‡ ÒËÏÔÚÓÏ‡ÚËÍ‡ (NIHSS 11 Ë 14) Ë ÌÂ·Î‡„ÓÔË-flÚÌÓ ‡Á‚ËÚËÂ (mRS 5 Ë 6), ÔÓ ASPECT Â‰ËÌËflÚ Ô‡ˆË-ÂÌÚ Â 5 ÚÓ˜ÍË, ‡ ‰Û„ËflÚ ÌÂ ÏÓÊ‡ ‰‡ ÒÂ ÓˆÂÌË. èË 8 Ô‡-ˆËÂÌÚË ÓÚÍËıÏÂ ËÁıÓ‰ÌÓ ÔÓ‚Ë¯‡‚‡ÌÂ Ì‡ CRP, Í‡ÚÓ ÌÂÒÂ ÓÚÍËı‡ ÌflÍ‡Í‚Ë ÚÂÌ‰ÂÌˆËË ÒÔflÏÓ ASPECT, Ò Ó„ÎÂ‰Ì‡ ÔÓ„ÌÓÁ‡Ú‡ ‚ „ÛÔ‡Ú‡ mRS 0-2 ÓÚÍÎÓÌÂÌËflÚ‡ Ò‡ 3 Í˙Ï8 ÌÓÏ‡ÎÌË ËÁıÓ‰ÌË ÂÁÛÎÚ‡ÚË, ‡ ‚ „ÛÔ‡Ú‡ mRS 3-6 Ò‡ 5Í˙Ï 5 ‚ „‡ÌËˆËÚÂ Ì‡ ÌÓÏ‡Ú‡.

èÓ˜ËÌ‡ÎË Ò‡ Ò˙ÓÚ‚ÂÚÌÓ ÚËÏ‡ ·ÓÎÌË ÓÚ Ô˙‚‡Ú‡ äí„ÛÔ‡ (ASPECT 2, 5, 6) Ë Â‰ËÌ ÓÚ ‚ÚÓ‡Ú‡ „ÛÔ‡(ASPECT 9, Ò Í‡ˆËÌÓÏ Ì‡ Ô‡ÌÍÂ‡Ò‡).

Ñàëäìëàü à àáÇéÑà

ÅÓÎÌËÚÂ Ò˙Ò 6 ËÎË ÔÓ-Ï‡ÎÍÓ ÚÓ˜ÍË ÔÓ ÒÍ‡Î‡Ú‡ASPECTS ËÏ‡Ú „ÓÎflÏ‡ ÏÓÁ˙˜Ì‡ ËÒıÂÏË˜Ì‡ Û‚Â‰‡. èÓ‰‡ÌÌË ÓÚ ÎËÚÂ‡ÚÛ‡Ú‡ ÚÓÁË ÂÁÛÎÚ‡Ú Â ÂÍ‚Ë‚‡ÎÂÌÚÂÌËÎË ÔÓ-ÁÌ‡˜ËÏ ÓÚ Ô‡‚ËÎÓÚÓ Á‡ Û‚Â‰‡ Ì‡ 1/3 ÓÚ ÚÂËÚÓ-ËflÚ‡ Ì‡ ëåÄ (6, 8). ÅÓÎÌËÚÂ Ò ASPECTS Ò˙Ò 7 ËÎË ÔÓ-Ï‡ÎÍÓ ÚÓ˜ÍË ËÏ‡Ú ÔÓ-Ï‡Î˙Í ¯‡ÌÒ Á‡ ÔÓÒÚË„‡ÌÂ Ì‡ mRS0-1 ËÎË 0-1-2, ‚ Ò‡‚ÌÂÌËÂ Ò ÚÂÁË Ì‡‰ 7 Ú. è‡ˆËÂÌÚËÚÂ Ò0-3 ÚÓ˜ÍË, ÔË ÍÓËÚÓ ÔÓ˜ÚË ˆflÎ‡Ú‡ ÚÂËÚÓËfl Â Á‡ÒÂ„-Ì‡Ú‡, Í‡ÚÓ ÔË Ì‡¯Ëfl ·ÓÎÂÌ Å.É.å. ËÏ‡Ú ÏËÌËÏ‡ÎÌË

¯‡ÌÒÓ‚Â Á‡ ‰Ó·Ó ÙÛÌÍˆËÓÌ‡ÎÌÓ ‚˙ÁÒÚ‡ÌÓ‚fl‚‡ÌÂ. íÂÁË ÍÓ-ËÚÓ ËÏ‡Ú 10 Ú, Ú.Â. ÔÓ˜ÚË ÌflÏ‡Ú ‡ÌÌË ËÒıÂÏË˜ÌË ÔÓ-ÏÂÌË, ËÏ‡Ú ÓÚÎË˜ÂÌ ¯‡ÌÒ Á‡ Ô˙ÎÌÓ ‚˙ÁÒÚ‡ÌÓ‚fl‚‡ÌÂ Ì‡ 3-fl ÏÂÒÂˆ (2,3). ASPECTS Â ÏÌÓ„Ó ÔÓÎÂÁÂÌ ÍÎËÌË˜ÂÌ ËÌ‰ËÍ‡-ÚÓ, ÔÓÍ‡Á‚‡˘ ÔË ÎÂ„ÎÓÚÓ Ì‡ ·ÓÎÌËfl Í‡Í˙‚ Â ‡ÁÏÂ˙ÚÌ‡ ‡ÌÌ‡Ú‡ ÏÓÁ˙˜Ì‡Ú‡ Û‚Â‰‡, ÌÂÁ‡‚ËÒËÏÓ ‰‡ÎË Ô‡ˆË-ÂÌÚ˙Ú Â Í‡Ì‰Ë‰‡Ú Á‡ íã ËÎË ÌÂ. èËÎÓÊÂÌËÂÚÓ Ì‡ tPA ÂÔÓÚË‚ÓÔÓÍ‡Á‡ÌÓ ÔË àåà _> 1/3 ÓÚ ëåÄ ËÎË ASPECTS<_ 7. ÔÓ‡‰Ë ‚ËÒÓÍ ËÒÍ ÓÚ ÒËÏÔÚÓÏ‡ÚË˜ÂÌ ËÌÚ‡Í‡ÌË-‡ÎÂÌ Í˙‚ÓËÁÎË‚ (6,7). èË ASPECTS 8 – 10 Ú. ÚÓÁË ËÒÍÂ 6.4%, ÔË ASPECTS 0 - 3, ˜ÂÒÚÓÚ‡Ú‡ Ì‡ Í˙‚ÓËÁÎË‚Ë-ÚÂ ‰ÓÒÚË„‡ 40% (Ï‡Í‡ Ë ÔË Ï‡Î˙Í ·ÓÈ ·ÓÎÌË ÒÔÓÂ‰ECASS II, 6 ˜‡Ò‡ ÒÎÂ‰ àåà)(5).

èÓÎÛ˜ÂÌËÚÂ ÓÚ Ì‡Ò ÂÁÛÎÚ‡ÚË ÔÓÚ‚˙Ê‰‡‚‡Ú ÛÒÚ‡-ÌÓ‚ÂÌ‡Ú‡ Ë ÓÚ ‰Û„Ë ‡‚ÚÓË ‚˙ÁÍ‡ ÏÂÊ‰Û ÓˆÂÌÍ‡Ú‡ ÔÓASPECT, ÚÂÊÂÒÚÚ‡ Ì‡ ÍÎËÌË˜Ì‡Ú‡ Í‡ÚËÌ‡, ËÁ‡ÁÂÌ‡˜ÂÁ NIHSS, Ë ÙÛÌÍˆËÓÌ‡ÎÌÓÚÓ ‚˙ÁÒÚ‡ÌÓ‚fl‚‡ÌÂ mRS Ì‡90-fl ‰ÂÌ. èÓ‰Ó·Ì‡ ‡ÒÓˆË‡ˆËfl ÒÂ ÛÒÚ‡ÌÓ‚fl‚‡ ÔË ÔËÂÚ‡-Ú‡ „‡ÌËˆ‡ ÔÓ ASPECT 7/8 ÚÓ˜ÍË, ÌÓ ÔË Ì‡¯Ëfl ÍÓÌÚËÌ-„ÂÌÚ Úfl Â ‰Ó·Â ËÁ‡ÁÂÌ‡ Ë ÔË „‡ÌËˆ‡ 6/7 ÚÓ˜ÍË.

Ç˙ÁÍ‡ Ò ËÒÍÓ‚ËÚÂ Ù‡ÍÚÓË ËÎË Ò Ô‡‡ÍÎËÌË˜ÌËÚÂËÁÒÎÂ‰‚‡ÌËfl ÌÂ ÒÂ ÓÚÍË. Ç˙Á ÓÒÌÓ‚‡ Ì‡ ÔÓÛ˜ÂÌËÚÂ ‰‡Ì-ÌË ÓÚ Ì‡¯Ëfl Ï‡Î˙Í ÍÓÌÚËÌ„ÂÌÚ ÒÂ ÔÓÚ‚˙Ê‰‡‚‡ ‰Ë‡„-ÌÓÒÚË˜Ì‡Ú‡ ÒÚÓÈÌÓÒÚ Ì‡ ÌÓ‚‡Ú‡ ÏÂÚÓ‰ËÍ‡ Á‡ ‡ÌÌ‡ äíÓˆÂÌÍ‡.

àÁ‡ÁÂÌËÚÂ ASPECT ÔÓÏÂÌË ÏÓ„‡Ú ‰‡ Ò‡ ·ÂÎÂ„ Ì‡ í-ÓÍÎÛÁËfl, Í‡ÚÓ Ú‡ÁË ËÌÙÓÏ‡ˆËfl ·Ë ÒÎÂ‰‚‡ÎÓ ‰‡ ÒÂ ËÁÔÓÎÁ-‚‡ ÔË ÓÔÂ‰ÂÎflÌÂ Ì‡ ÚÂ‡ÔÂ‚ÚË˜ÌËfl ÔÓ‰ıÓ‰.

Ö‰Ì‡ ÓÚ ‚ÚÓË˜ÌËÚÂ ˆÂÎË Ì‡ ÔÓÛ˜‚‡ÌÂÚÓ ·Â¯Â ÔÓ-‰Ó·fl‚‡ÌÂ Ì‡ ÚÓ˜ÌÓÒÚÚ‡ Ì‡ ÔÓ„ÌÓÁ‡Ú‡ ˜ÂÁ ÍÓÏ·ËÌË‡-ÌÂ Ì‡ ASPECT Ò NIHSS Ë ÑëÉ ‰‡ÌÌË. á‡·ÂÎflÁ‚‡ ÒÂ ‚˙ÁÍ‡ÏÂÊ‰Û ÑëÉ Ì‡ıÓ‰Í‡ Ë ‡ÌÌËÚÂ äí ÔÓÏÂÌË. Ç ÎËÚÂ‡ÚÛ-‡Ú‡ Ò‡ ÔÛ·ÎËÍÛ‚‡ÌË ÔÓ„ÌÓÒÚË˜ÌËÚÂ ÍÓÏ·ËÌ‡ˆËË Ì‡‰‡ÌÌË ÓÚ NIHSS Ò ÑëÉ Ë NIHSS Ò ASPECTS (3). ç‡ ÚÓÁËÂÚ‡Ô, ÔÓ‡‰Ë Ï‡ÎÍËfl ·ÓÈ Ô‡ˆËÂÌÚË Ú‡Í˙‚ ‡Ì‡ÎËÁ ÌÂ ÏÓ-Ê‡ ‰‡ ·˙‰Â Ì‡Ô‡‚ÂÌ.

çflÍÓË Ô‡ÍÚË˜ÂÒÍË ËÁ‚Ó‰Ë ‚˙‚ ‚˙ÁÍ‡ Ò ËÁ‚˙¯‚‡ÌÂ-ÚÓ Ì‡ ÓˆÂÌÍ‡Ú‡ ÔÓ ASPECT Ò‡ ÒÎÂ‰ÌËÚÂ. ç‡¯ËflÚ äí‡Ô‡‡Ú Â ÓÚ ÒÚ‡Ó ÔÓÍÓÎÂÌËÂ, Ò˙Ò ÒÎ‡·‡ ÏÓ˘ÌÓÒÚ Ì‡ÂÌÚ„ÂÌÓ‚Ó ËÁÎ˙˜‚‡ÌÂ, ÔÓ‡‰Ë ÍÓÂÚÓ Ò˜ËÚ‡ÏÂ, ˜Â ÌÂ‚ÒË˜ÍË ‡ÌÌË ·ÂÎÂÁË ÏÓ„‡Ú ‰‡ ·˙‰‡Ú ËÁÓ·‡ÁÂÌË Í‡ÍÚÓ Ì‡Â‰ËÌ ÌÓ‚ ÒÔË‡ÎÂÌ ÏÛÎÚËÒÎ‡ÈÒ ÒÍÂÌÂ. éˆÂÌÍ‡Ú‡ Ì‡ ÏÓÌË-ÚÓ ÔÓÁ‚ÓÎfl‚‡ ÔÓ-‰Ó·‡ ‚Ë‰ËÏÓÒÚ Ì‡ ‰ÂÚ‡ÈÎËÚÂ Ë ÔÓ-ÔÂˆËÁÂÌ ÚÓ˜ÍÓ‚ ÂÁÛÎÚ‡Ú. å‡ÎÍË ÓÚ‡ˆËË Ì‡ „Î‡‚‡Ú‡Ì‡ Ô‡ˆËÂÌÚ‡ ÔÓÁ‚ÓÎfl‚‡Ú ÓˆÂÌfl‚‡ÌÂ, ÌÓ ‚ÎÓ¯‡‚‡Ú ÚÓ˜ÌÓ-ÒÚÚ‡ Ì‡ ÓˆÂÌÍ‡Ú‡. ç‡ÎË˜ËÂÚÓ Ì‡ ÒÚ‡Ë ËÒıÂÏË˜ÌË ËÌˆË-


îË„Û‡ 1. Ñ‚ÂÚÂ ‡‚ÌËÌË Ì‡ ÒÍÂÌË‡ÌÂ Ò ‰ÂÒÂÚÚÂ ÁÓÌË Ì‡ ËÒıÂÏË˜ÌË ÔÓÏÂÌË ‚ ·‡ÒÂËÌ‡ Ì‡ ëåÄ, ÍÓËÚÓ ‰‡‚‡Ú ÔÓ Â‰Ì‡ ÚÓ˜Í‡ ‚ ASPECTS Ò·Ó‡. (ÔÓPexman et al. American Journal of Neuroradiology 2001, 22:1534-1542)

‰ÂÌÚË Ë Ò˙Ô˙ÚÒÚ‚‡˘Ë ÏÓÁ˙˜ÌË Á‡·ÓÎfl‚‡ÌËfl ÒËÎÌÓ Á‡Ú-Û‰Ìfl‚‡Ú ÓˆÂÌÍ‡Ú‡.


àÁıÓ‰˙Ú ÒÂ‰ àåà Â ·ËÎ ÔÓ-‰Ó·˙ ÔË ËÁÒÎÂ‰‚‡ÌËÚÂ ÒÔÓ-„ÓÎflÏ ASPECTS Ò·Ó, ÌÓ ËÌ‚‡ÎË‰ÌÓÒÚÚ‡ Ì‡ 1-fl Ë 3-flÏÂÒÂˆ Ë ËÁıÓ‰‡ ÓÚ Á‡·ÓÎfl‚‡ÌÂÚÓ ÌÂ Á‡‚ËÒflÚ Ò‡ÏÓ ÓÚ ‡Ì-Ì‡Ú‡ äí ÓˆÂÌÍ‡. éˆÂÌfl‚‡ÌÂÚÓ Ì‡ äí ÔÓÏÂÌËÚÂ ÒÔÓÂ‰ASPECTS ËÁËÒÍ‚‡ ÒÔÂˆËÙË˜ÌÓ Ó·Û˜ÂÌËÂ Ë ÂÍÒÔÂÚËÁ‡ ÓÚÒÚ‡Ì‡ ÂÌÚ„ÂÌÓÎÓÁËÚÂ Ë ÌÂ‚ÓÎÓÁËÚÂ ‚ Ì‡¯‡Ú‡ ÒÚ‡Ì‡,Í‡ÚÓ ÚÓÁË Ì‡˜ËÌ ÔÓ-ÔÂˆËÁÌÓ ÏÓÊÂ ‰‡ ÒÂ ‰ÂÙËÌË‡ ÔÓ„-ÌÓÁ‡Ú‡ ÔË ÔÓ‰„ÛÔËÚÂ ·ÓÎÌË Ò àåà Ë ÚÂ‡ÔÂ‚ÚË˜Ì‡Ú‡ÒÚ‡ÚÂ„Ëfl.

ãàíÖêÄíìêÄ1. Barber PA, Demchuk AM, Hill MD, Pexman W, Hudon ME, Tomanek A,

Beaupre D, Frayne R, Buchan AM. A comparison of CT versus MR imagingin acute stroke using ASPECTS: will the "new" replace the "old" as the pre-ferred Imaging modality? Stroke. 2001; 32: 325. Abstract

2. Csiba L, Stroke and neurosonology, Lecture, Danube University - Krems,Oct 2006.

3. Demchuk AM, M. D. Hill, P. A. Barber, B. Silver, S. C. Patel, S. R. Levine,and for the NINDS rtPA Stroke Study Group, NIH. Importance of EarlyIschemic Computed Tomography Changes Using ASPECTS in NINDS rtPAStroke Study. Stroke, 2005; 36: 2110 - 2115.

4. Dippel DW, Du Ry van Beest Holle M, van Kooten F, Koudstaal PJ. Thevalidity and reliability of signs of early infarction on CT in acute ischaemicstroke. Neuroradiology 2000; 42: 629-633.

5. Hacke W, Kaste M, Fieschi C, von Kummer R, Davalos A, Meier D, LarrueV, Bluhmki E, Davis S, Donnan G, Schneider D, Diez-Tejedor E, Trouillas P,Randomised double-blind placebo-controlled trial of thrombolytic therapy

with intravenous alteplase in acute ischemic stroke (ECASS II). SecondEuropean-Australasian acute stroke study investigators, Lancet, 1998, Oct 17,352 (9136): 1245-51.

6. Hill MD, A.M. Demchuk, T.A. Tomsick, Y.Y. Palesch, J.P. Broderick, and onbehalf of the IMS-1 Investigators. Using the Baseline CT Scan to SelectAcute Stroke Patients for IV-IA Therapy. Am J Neuroradiol 2006; 27: 1612 -1616.

7. Hill MD, Rowley HA, Adler F, Eliasziw M, Furlan A, Higashida RT,Weschler LR, Roberts HC, Dillon WP, Fischbein NJ, Firszt CA, Schulz G,Buchan AM, Selection of acute ischemic stroke patients for intra-arterialthrombolysis with prourokinase using ASPECTS. Stroke 2003; 34:1925–1931.

8. Kalafut MA, DL Schriger, JL Saver, S. Starkman. Detection of Early CTSigns of >1/3 Middle Cerebral Artery Infarctions: Interrater Reliability andSensitivity of CT Interpretation by Physicians Involved in Acute Stroke Care.Stroke 2000; 31: 1667 - 1671.

9. Kent DM, HP Selker, R. Ruthazer, E. Bluhmki, W. Hacke. The Stroke-Thrombolytic Predictive Instrument: A Predictive Instrument for IntravenousThrombolysis in Acute Ischemic Stroke. Stroke 2006; 37: 2957 - 2962.

10. Mak H. K.F., K. K.W. Yau, P.-L. Khong, A. S.C. Ching, P.-W. Cheng, P.K.M. Au-Yeung, P. K.M. Pang, K. C.W. Wong, and B. P.L. Chan.Hypodensity of >1/3 Middle Cerebral Artery Territory Versus Alberta StrokeProgramme Early CT Score (ASPECTS): Comparison of Two Methods ofQuantitative Evaluation of Early CT Changes in Hyperacute Ischemic Strokein the Community Setting. Stroke 2003; 34: 1194 - 1196.

11. Pexman JH, Barber PA, Hill MD, Sevick RJ, Demchuk AM, Hudon ME, HuWY, Buchan AM. Use of the Alberta Stroke Program Early CT Score(ASPECTS) for assessing CT scans in patients with acute stroke. AJNR Am JNeuroradiol. 2001; 22: 1534–1542.

12. Pexman JHW, M. D. Hill, A. M. Buchan, A. M. Demchuk, P. A. Barber, J. E.Simon, S. B. Coutts, D. Saur, J. Rother, and T. Kucinski. Hyperacute Stroke:Experience Essential When Reading Unenhanced CT Scans. Am JNeuroradiol 2004; 25: 516 - 518.

13. Schriger D, Kalafut M, Starkman S, et al. Cranial computed tomographyinterpretation in acute stroke: physicians' accuracy in determining eligibilityfor thrombolytic therapy. JAMA 1998; 279:1293-1297.

14. The National Institute of Neurological Disorders and Stroke (NINDS) rt-PAStroke Study Group. Effect of intravenous recombinant tissue plasminogenactivator on ischemic stroke lesion size measured by computed tomography.Stroke 2000; 31: 2912–2919.


îË„Û‡ 2‡. è‡ˆËÂÌÚ ÇëÇ, 60 „Ó‰. Ò àåà ‚ ÅÑëåÄ ÓˆÂÌÂÌ Ò 2 ÚÓ˜ÍË ÔÓ ASPECT

îË„Û‡ 2·. è‡ˆËÂÌÚ ï.ç.ñ, 68 „Ó‰. Ò àåà ‚ ÅÑëåÄ ÓˆÂÌÂÌ Ò 5 ÚÓ˜ÍË ÔÓ ASPECT

15. The National Institute of Neurological Disorders and Stroke rt-PA StrokeStudy Group. Tissue plasminogen activator for acute hemisphere stroke. NEngl J Med 1995; 333:1581-1587.

16. Wardlaw JM, Dorman PJ, Lewis SC, Sandercock PAG. Can stroke physiciansand neurologists identify signs of early cerebral infarction on CT? J NeurolNeurosurg Psychiatry 1999; 67: 651-653.

17. Wardlaw JM, O. Mielke. Early Signs of Brain Infarction at CT: ObserverReliability and Outcome after Thrombolytic Treatment--Systematic Review.Radiology 2005; 235: 444 - 453.

18. Shelagh B. Coutts, Michael D. Hill, Andrew M. Demchuk, Philip A. Barber,MB, J.H. Warwick Pexman, MB, FRCR Alastair M. Buchan. ASPECTSReading Requires Training and Experience. StrokÂ 2003; 34:e179.

19. von Kummer R, Allen KL, Holle R, Bozzao L, Bastianello S, Manelfe C,Bluhmki E, Ringleb P, Meier DH, Hacke W, Acute stroke: usefulness of early

CT findings before thrombolytic therapy, Radiology, 1997, 205, 327-333.

Ä‰ÂÒ Á‡ ÍÓÂÒÔÓÌ‰ÂÌˆËfl:Ñ- å. äÎËÒÛÒÍË, ‰Ï, „Î. ‡ÒËÒÚÂÌÚäÎËÌËÍ‡ ÔÓ ÌÂ‚ÓÎÓ„ËflåÅÄã “ñ‡Ëˆ‡ âÓ‡ÌÌ‡” - ëÓÙËflìÎ. “ÅflÎÓ ÏÓÂ” ‹ 8, 1527 ëÓÙËflíÂÎ: (+359 2) 9432 597 / 160Ö-mail: [email protected]


SUMMARY

HIP-SPINE SYNDROME BEFORE AND AFTER TOTALHIP REPLACEMENT

P. Atanassova, A. Atanassov, N. Traykova, M. Semerdjieva,I. Koleva

OBJECTIVE: Hip osteoarthritis frequently causes low-back pain. Hip-spine syndrome is a constellation of symptomsof overlap of radiculopathy and lower extremity arthritis.

PURPOSE: To describe the clinical findings of hip-spinesyndrome in 43 consecutive patients before and after total hipreplacement.

RESULTS: Forty three patients were evaluated. Our studyreports 6 patients without hip osteoarthritis. Hip osteoarthritiswas mild in 4 patients, moderate in 33, and bilateral in 4patients. Total hip replacement (THR) was performed in 31patients. The mean hip pain VAS score was 7.2 before THRand 2.4 after surgery (P>0,001). Both spinal and hip pain andfunction were significantly better following THR.

CONCLUSION: The study demonstrates the clinical bene-fits of THR on low back pain.

KEY WORDS: low back pain, radiculopathy, hiposteoarthritis, hip-spine syndrome, total hip replacement.

êÖáûåÖ

ÇöÇÖÑÖçàÖ: äÓÍÒ‡ÚÓÁ‡Ú‡ ˜ÂÒÚÓ ÔË˜ËÌfl‚‡ ·ÓÎÍ‡‚ Í˙ÒÚ‡ Hip-spine ÒËÌ‰ÓÏ˙Ú Â Ò˙‚ÍÛÔÌÓÒÚ ÓÚ ÒËÏÔÚÓ-ÏË Ì‡ ÔËÔÓÍË‚‡ÌÂ Ì‡ ÔËÁÌ‡ˆËÚÂ Ì‡ ‡‰ËÍÛÎÓÔ‡ÚËfl Ë‡ÚËÚ Ì‡ ‰ÓÎÂÌ Í‡ÈÌËÍ.

ñÖã: äÎËÌË˜ÌÓ ÓÔËÒ‡ÌËÂ Ì‡ hip-spine ÒËÌ‰ÓÏ ÔË 43Ô‡ˆËÂÌÚË ÔÂ‰Ë Ë ÒÎÂ‰ ÂÌ‰ÓÔÓÚÂÁË‡ÌÂ Ì‡ Ú‡ÁÓ·Â‰ÂÌ‡-Ú‡ ÒÚ‡‚‡.

êÖáìãíÄíà: éˆÂÌÂÌË ·flı‡ 43 Ô‡ˆËÂÌÚË. ç‡¯ÂÚÓ ÔÓ-Û˜‚‡ÌÂ ‰ÓÍÎ‡‰‚‡ 6 Ô‡ˆËÂÌÚ‡ ·ÂÁ ÍÓÍÒ‡ÚÓÁ‡. äÓÍÒ‡Ú-ÓÁ‡Ú‡ ·Â ÎÂÍ‡ ÔË 4 Ô‡ˆËÂÌÚ‡, ÛÏÂÂÌÓ ÚÂÊÍ‡ ÔË 33 Ë‰‚ÛÒÚ‡ÌÌ‡ ÔË 4 Ô‡ˆËÂÌÚ‡. ÖÌ‰ÓÔÓÚÂÁË‡ÌÂ Ì‡ Ú‡ÁÓ-·Â‰ÂÌ‡Ú‡ ÒÚ‡‚‡ ÒÂ ÔÓ‚Â‰Â ÔË 31 Ô‡ˆËÂÌÚË. ëÂ‰Ì‡Ú‡ÒÚÓÈÌÓÒÚ Ì‡ ‚ËÁÛ‡ÎÌ‡Ú‡ ‡Ì‡ÎÓ„Ó‚‡ ÒÍ‡Î‡ (ÇÄë) ÔÂ‰Ë ÂÌ-‰ÓÔÓÚÂÁË‡ÌÂÚÓ ·Â 7.2, ‡ ÒÎÂ‰ ÂÌ‰ÓÔÓÚÂÁË‡ÌÂÚÓ – 2.4(P>0,001). ëÎÂ‰ ÂÌ‰ÓÔÓÚÂÁË‡ÌÂÚÓ ÒÂ ÓÚ˜ÂÚÂ ÁÌ‡˜ËÏÓÔÓ‰Ó·ÂÌËÂ Ì‡ ·ÓÎÍ‡Ú‡ Ë ÙÛÌÍˆËflÚ‡ Í‡ÍÚÓ ‚ „˙·Ì‡Í‡,

Ú‡Í‡ Ë ‚ Ú‡ÁÓ·Â‰ÂÌ‡Ú‡ ÒÚ‡‚‡.áÄäãûóÖçàÖ: èÓÛ˜‚‡ÌÂÚÓ ÔÂ‰ÒÚ‡‚fl ·Î‡„ÓÔË-

flÚÌËfl ÍÎËÌË˜ÂÌ ÂÙÂÍÚ Ì‡ ÂÌ‰ÓÔÓÚÂÁË‡ÌÂÚÓ Ì‡ Ú‡ÁÓ-·Â‰ÂÌ‡Ú‡ ÒÚ‡‚‡ ‚˙ıÛ ·ÓÎÍ‡Ú‡ ‚ Í˙ÒÚ‡.

◊Hip-spine” ÒËÌ‰ÓÏ˙Ú ÔÂ‰ÒÚ‡‚Îfl‚‡ ÍÓÌÒÚÂÎ‡ˆËfl ÓÚ◊ÒËÏÔÚÓÏË Ì‡ ÔËÔÓÍË‚‡ÌÂ” ÏÂÊ‰Û ·ÓÎÍË ‚ Í˙ÒÚ‡ Ë‡ÚÓÁÌÓ ÔÂ‰ËÁ‚ËÍ‡ÌË ·ÓÎÍË ‚ ‰ÓÎÌËfl Í‡ÈÌËÍ (4). Ç Ï‡-˘‡·ÌÓ ÔÓÛ˜‚‡ÌÂ Ì‡ Hazlett JW (5), ÔÓÒ‚ÂÚÂÌÓ Ì‡ ·ÓÎÍËÚÂ‚ Í˙ÒÚ‡ Â ÛÒÚ‡ÌÓ‚ÂÌÓ, ˜Â 10% ÓÚ Ô‡ˆËÂÌÚËÚÂ ËÏ‡Ú ÙÂ-ÏÓ‡ÎÌÓ, ‡ ÌÂ Ë¯Ë‡Î„Ë˜ÌÓ ‡ÁÔÓÒÚ‡ÌÂÌËÂ Ì‡ Í˙ÒÚÌ‡-Ú‡ ·ÓÎÍ‡ - Ì‡ıÓ‰Í‡, ÍÓflÚÓ Á‡ÚÛ‰Ìfl‚‡ ÚÓÔË˜Ì‡Ú‡ ‰Ë‡„-ÌÓÁ‡: ÒÔËÌ‡ÎÌ‡ ÎË Â ·ÓÎÍ‡Ú‡ ËÎË ÒÂ ‰˙ÎÊË Ì‡ ·ÓÎÂÒÚÌËÔÓÏÂÌË ‚ „ÓÎÂÏËÚÂ ÒÚ‡‚Ë Ì‡ ‰ÓÎÌËfl Í‡ÈÌËÍ (Ú‡ÁÓ·Â‰-ÂÌ‡, ÍÓÎflÌÌ‡)?

äÓÍÒ‡ÚÓÁ‡Ú‡, „ÓÌ‡ÚÓÁ‡Ú‡, ‡ÒÂÔÚË˜Ì‡Ú‡ ÌÂÍÓÁ‡Ì‡ „Î‡‚‡Ú‡ Ì‡ ·Â‰ÂÌ‡Ú‡ ÍÓÒÚ Ë ÔÂË‡ÚËÚ˙Ú Ì‡ Ú‡ÁÓ-·Â‰ÂÌ‡Ú‡ ÒÚ‡‚‡ ÏÓ„‡Ú ‰‡ Ò˙Á‰‡‰‡Ú ÒÂËÓÁÌË ‰ËÙÂÂÌ-ˆË‡ÎÌÓ-‰Ë‡„ÌÓÒÚË˜ÌË ÔÓ·ÎÂÏË. Ç ÚÂÁË ÒÎÛ˜‡Ë Ô‡ˆËÂÌ-ÚËÚÂ Ó·ËÍÌÓ‚ÂÌÓ ÒÂ ÓÔÎ‡Í‚‡Ú ÓÚ ·ÓÎÍ‡ ÔÓ ÔÂ‰Ì‡Ú‡˜‡ÒÚ Ì‡ ·Â‰ÓÚÓ, ‚ ÌflÍÓË ÒÎÛ˜‡Ë ÔË‰ÛÊÂÌ‡ Ë ÓÚ ·ÓÎÍË‚ Í˙ÒÚ‡ (2).

á‡·ÓÎfl‚‡ÌÂÚÓ ÍÓÍÒ‡ÚÓÁ‡ ÒÂ ÔÂ‰ÒÚ‡‚fl ÍÎËÌË˜ÌÓ ÒÛÔÓËÚ‡ Â‰ÌÓÒÚ‡ÌÌ‡ ËÎË ‰‚ÛÒÚ‡ÌÌ‡ ·ÓÎÍ‡ (ÔË ‰‚ÛÒÚ-‡ÌÌ‡ Û‚Â‰‡) ‚ ËÎËÓËÌ„‚ËÌ‡ÎÌ‡Ú‡ Ó·Î‡ÒÚ, ÍÓflÚÓ ÒÂ Á‡-ÒËÎ‚‡ ÔË ıÓ‰ÂÌÂ, Ò Ë‡‰Ë‡ˆËfl Í˙Ï ·Â‰ÓÚÓ, ‡‰‰ÛÍÚÓË-ÚÂ Ë ÍÓÎflÌÓÚÓ; ‰‚ËÊÂÌËflÚ‡ ‚ ÒÚ‡‚‡Ú‡ ÒÂ Ó„‡ÌË˜‡‚‡Ú,ÔÓıÓ‰Í‡Ú‡ ÒÚ‡‚‡ Ì‡ÍÛˆ‚‡˘‡ ËÎË Ô‡ÚÂ¯Í‡. äÓ„‡ÚÓ ·ÓÎ-Í‡Ú‡ ÒÂ ÔÂ‰ËÁ‚ËÍ‚‡ ÓÚ ÒÚÛÍÚÛÌË ÔÓÏÂÌË ÔÓ Á‡‰Ì‡-Ú‡ ÔÓ‚˙ıÌÓÒÚ Ì‡ Ú‡ÁÓ·Â‰ÂÌ‡Ú‡ ÒÚ‡‚‡ Úfl Ò˙‚Ô‡‰‡ Ò ÂÒ-ÚÂÒÚ‚ÂÌËfl ıÓ‰ Ì‡ n. ischiadiÒus Ë ÚÛ‰ÌÓ ÒÂ ‡Á„‡ÌË˜‡‚‡ÓÚ ÎÛÏ·Ó‡‰ËÍÛÎÂÌ‡Ú‡ ·ÓÎÍ‡ ËÎË ÓÚ Ú‡ÁË Ì‡ Ò‡ÍÓËÎË-‡˜Ì‡Ú‡ ÒÚ‡‚‡ (1).

éÔÂ‡ÚË‚Ì‡Ú‡ ÒÏflÌ‡ (ÂÌ‰ÓÔÓÚÂÁË‡ÌÂÚÓ) Ì‡ Ú‡ÁÓ-·Â‰ÂÌ‡Ú‡ ÒÚ‡‚‡ ÔÂÍ‡Úfl‚‡ ÎÓÍ‡ÎÌ‡Ú‡ ·ÓÎÍ‡ ‚ Ó·Î‡ÒÚ-Ú‡ Ì‡ ÒÚ‡‚‡Ú‡, ‡ ÔÓ‚ÓÍË‡Ì‡Ú‡ ·ÓÎÍ‡ ‚ Í‡ÎflÌÓÚÓ ËÁ˜ÂÁ-‚‡. ëÎÂ‰ Ô‡‚ËÎÌÓ ÔÓ‚Â‰ÂÌ‡ Âı‡·ËÎËÚ‡ˆËfl ‚ ÒÎÂ‰ÓÔÂ‡-ÚË‚ÌËfl ÔÂËÓ‰ Ô‡‚ËÎÌ‡Ú‡ ÔÓıÓ‰Í‡ ÒÂ ‚˙ÁÒÚ‡ÌÓ‚fl‚‡, ·ÂÁÌ‡ÍÛˆ‚‡ÌÂ Ë ◊ÎÛÏ·Ó-Ò‡Í‡ÎÌËfl ‡‰ËÍÛÎËÚ” ÒÂ Ó·ÎÂÍ˜‡‚‡ÁÌ‡˜ËÏÓ (3).

éË„ËÌ‡ÎÌË ÒÚ‡ÚËËHIP-SPINE ëàçÑêéå èêÖÑà à ëãÖÑ ÖçÑéèêéíÖáàêÄçÖ

çÄ íÄáéÅÖÑêÖçÄ ëíÄÇÄ

è. Ä. ÄÚ‡Ì‡ÒÓ‚‡1, Ä. ÄÚ‡Ì‡ÒÓ‚2, ç. í‡ÈÍÓ‚‡3,å. ëÂÏÂ‰ÊËÂ‚‡4, à. äÓÎÂ‚‡5

1ä‡ÚÂ‰‡ ÔÓ ÌÂ‚ÓÎÓ„Ëfl, åÂ‰ËˆËÌÒÍË ìÌË‚ÂÒËÚÂÚ, èÎÓ‚‰Ë‚2ä‡ÚÂ‰‡ ÔÓ ÓÚÓÔÂ‰Ëfl Ë Ú‡‚Ï‡ÚÓÎÓ„Ëfl, åÂ‰ËˆËÌÒÍË ìÌË‚ÂÒËÚÂÚ, èÎÓ‚‰Ë‚

3ä‡ÚÂ‰‡ ÔÓ Ó·‡ÁÌ‡ ‰Ë‡„ÌÓÒÚËÍ‡, åÂ‰ËˆËÌÒÍË ìÌË‚ÂÒËÚÂÚ, èÎÓ‚‰Ë‚4ä‡ÚÂ‰‡ ÔÓ ÒÓˆË‡ÎÌ‡ ÏÂ‰ËˆËÌ‡ Ë Á‰‡‚ÂÌ ÏÂÌË‰ÊÏ¸ÌÚ, åÂ‰ËˆËÌÒÍË ìÌË‚ÂÒËÚÂÚ, èÎÓ‚‰Ë‚

5ä‡ÚÂ‰‡ ÔÓ ÙËÁËÍ‡ÎÌ‡ ÏÂ‰ËˆËÌ‡, Âı‡·ËÎËÚ‡ˆËfl, Â„ÓÚÂ‡ÔËfl Ë ÒÔÓÚ, åÂ‰ËˆËÌÒÍË ìÌË‚ÂÒËÚÂÚ, èÎÂ‚ÂÌ

ñÖã

äÎËÌË˜ÌÓ ÓÔËÒ‡ÌËÂ Ì‡ ◊hip-spine” ÒËÌ‰ÓÏ‡ ÔË Ô‡ˆË-ÂÌÚË ÔÂ‰Ë Ë ÒÎÂ‰ ÂÌ‰ÓÔÓÚÂÁË‡ÌÂ Ì‡ Ú‡ÁÓ·Â‰ÂÌ‡Ú‡ÒÚ‡‚‡.

äéçíàçÉÖçí à åÖíéÑà

á‡ ÔÂËÓ‰ ÓÚ 2 „Ó‰ËÌË (2004-2006 „) ‚ ‡Ï·ÛÎ‡ÚÓÌËÚÂÛÒÎÓ‚Ëfl Ì‡ ÌÂ‚ÓÎÓ„Ë˜ÂÌ Í‡·ËÌÂÚ, ÓÚ ÒÎÛ˜‡ÂÌ ÔÓ‰·Ó Ò‡ÒÂÎÂÍÚË‡ÌË 43 Ô‡ˆËÂÌÚË (16 Ï˙ÊÂ Ë 27 ÊÂÌË) Ì‡ ÒÂ‰Ì‡‚˙Á‡ÒÚ 68±7,2 „Ó‰., ÒÔÓÂ‰ ËÁ·‡ÌËÚÂ ÍËÚÂËË Á‡‚ÍÎ˛˜‚‡ÌÂ ‚ ÔÓÛ˜‚‡ÌÂÚÓ Ë ÙÓÏË‡ÌÂ Ì‡ ÒÚ‡ÌÓ‚Ë˘Â Á‡Ì‡ÎË˜ËÂ Ì‡ ◊hip-spine” ÒËÌ‰ÓÏ:

● Ô‡ˆËÂÌÚË Ò ‰˙Î„Ó„Ó‰Ë¯Ì‡ ‡Ì‡ÏÌÂÁ‡ Á‡ ·ÓÎÍË ‚ Í˙Ò-Ú‡, Ò ÛÚÓ˜ÌÂÌ‡ ÌÂ‚ÓÎÓ„Ë˜Ì‡ ‰Ë‡„ÌÓÁ‡ Ë ÎÂÍÛ‚‡ÌËÏÌÓ„ÓÍ‡ÚÌÓ Á‡ ÂˆË‰Ë‚Ë‡˘Ë ÎÛÏ·ÓÒ‡Í‡ÎÌË ‡‰Ë-ÍÛÎÓÔ‡ÚËË Ò ‰Â„ÂÌÂ‡ÚË‚ÂÌ ÒÔËÌ‡ÎÂÌ ÔÓËÁıÓ‰ (ËÁ‚˙-ÌÚ‡‚ÏÂÌ‡, ‚˙ÁÔ‡ÎËÚÂÎÌ‡ Ë ÌÂÓÔÎ‡ÁÏÂÌ‡ ÂÚËÓÎÓ„Ëfl)(ÙË„. 1)

● Ô‡ˆËÂÌÚË Ò ‡Ì‡ÏÌÂÁÌË ‰‡ÌÌË Á‡ Á‡ÒËÎ‚‡ÌÂ Ì‡ ◊ÒÚ‡Ë-ÚÂ”, ‚Â˜Â ÔÓÁÌ‡ÚË ·ÓÎÍË ‚ Í˙ÒÚ‡ Ò ÔÓfl‚‡Ú‡ Ì‡ ÌÓ-‚‡, ÎÓÍ‡ÎÌ‡ ·ÓÎÍ‡ ‚ ËÎËÓËÌ„‚ËÌ‡ÎÌ‡Ú‡ Ó·Î‡ÒÚ, Ë‡-‰ËË‡˘‡ ÔÓ ÔÂ‰Ì‡Ú‡ ÔÓ‚˙ıÌÓÒÚ Ì‡ ·Â‰ÓÚÓ ‰Ó ÍÓ-ÎflÌÓÚÓ.

● Ò ‰‡ÌÌË ÓÚ ÌÂ‚ÓÎÓ„Ë˜ÌËfl ÒÚ‡ÚÛÒ Á‡ ÎÛÏ·Ó-Ò‡Í‡-ÎÂÌ(Ë) ÍÓÂÌ˜Â‚(Ë) ÒËÌ‰ÓÏ(Ë) Ë ÍÓÍÒ‡ÚÓÁ‡ (Ó„‡-ÌË˜ÂÌ‡ Ë ·ÓÎÂÁÌÂÌ‡ ÙÎÂÍÒËfl, ‡·‰ÛÍˆËfl, ‚¸Ì¯Ì‡ ÓÚ‡-ˆËfl Ë ÂÍÒÚÂÌÁËfl ‚ Ú‡ÁÓ·Â‰ÂÌ‡ ÒÚ‡‚‡ Ì‡‰ 70°).

èË ‚ÒË˜ÍË Ô‡ˆËÂÌÚË ÒÂ ÓÒ˙˘ÂÒÚ‚Ë ÂÌÚ„ÂÌÓ„‡ÙËflÌ‡ Ú‡Á Ò ‡Á˜ËÚ‡ÌÂ ÓÚ ÂÌÚ„ÂÌÓÎÓ„ Ë ÍÓÌÒÛÎÚ‡ÚË‚ÂÌÔÂ„ÎÂ‰ ÓÚ ÓÚÓÔÂ‰-Ú‡‚Ï‡ÚÓÎÓ„ Á‡ ÔËÂÏ‡ÌÂ ËÎË ËÁÍ-

Î˛˜‚‡ÌÂ Ì‡ ÔË‰ÛÊ‡‚‡˘Ó Á‡·ÓÎfl‚‡ÌÂ ÍÓÍÒ‡ÚÓÁ‡.ëÎÂ‰ ËÌÙÓÏË‡ÌÓ Ò˙„Î‡ÒËÂ, ÔË Ô‡ˆËÂÌÚËÚÂ Ò ‰ÓÍ‡Á‡-

Ì‡ ÚÂÊÍÓÒÚÂÔÂÌÌ‡ ÍÓÍÒ‡ÚÓÁ‡, ÒÂ ÔÓ‚Â‰Â ËÌ‚‡ÁË‚ÌÓÎÂ˜ÂÌËÂ - ÂÌ‰ÓÔÓÚÂÁË‡ÌÂ Ì‡ Ú‡ÁÓ·Â‰ÂÌ‡ ÒÚ‡‚‡.

èÂ‰Ë Ë ÒÎÂ‰ÓÔÂ‡ÚË‚ÌÓ (Ì‡ 3 ÏÂÒÂˆ) ÒÂ ÓÚ˜ÂÚÂ ËÒ‡‚ÌË ÒËÎ‡Ú‡ Ì‡ ·ÓÎÍ‡Ú‡ ‚ Í˙ÒÚ‡ Ë ‚ ËÌ„‚ËÌ‡ÎÌ‡Ú‡ Ó·-Î‡ÒÚ ÔÓ ‚ËÁÛ‡ÎÌ‡ ‡Ì‡ÎÓ„Ó‚‡ ÒÍ‡Î‡ (ÇÄë) (3).

ëÚ‡ÚËÒÚË˜ÂÒÍ‡Ú‡ Ó·‡·ÓÚÍ‡ Ì‡ ‰‡ÌÌËÚÂ ÒÂ ËÁ‚˙¯ËÒ ‚‡Ë‡ˆËÓÌÂÌ, ‡ÎÚÂÌ‡ÚË‚ÂÌ Ë „‡ÙË˜ÂÌ ‡Ì‡ÎËÁË.

êÖáìãíÄíà

ç‡ Ú‡·Î. 1 Ò‡ ÔÂ‰ÒÚ‡‚ÂÌË ÂÁÛÎÚ‡ÚËÚÂ ÓÚ ÌÂ‚ÓÎÓ-„Ë˜ÌËfl ÔÂ„ÎÂ‰ Ì‡ 43 Ô‡ˆËÂÌÚË Á‡ Ì‡ÎË˜ËÂ Ì‡ ◊ÔËÔÓÍË-‚‡˘Ë ÒÂ” ÒËÏÔÚÓÏË ÓÚ ÎÛÏ·Ó-Ò‡Í‡ÎÂÌ ‡‰ËÍÛÎËÚ (Â‰ÌÓ-ÒÚ‡ÌÂÌ ËÎË ‰‚ÛÒÚ‡ÌÂÌ) Ë ÙÂÏÓ‡ÎÌÓ ‡ÁÔÓÒÚ‡ÌÂÌËÂÌ‡ ·ÓÎÍ‡ ÓÚ ËÎËÓËÌ„‚ËÌ‡ÎÌ‡ Ó·Î‡ÒÚ, ÍÓËÚÓ ‚ ‡Ï·ÛÎ‡ÚÓ-ÌË ÛÒÎÓ‚Ëfl Ò‡ ÚÂÒÚ‚‡ÌË Í‡ÚÓ Â‰ÌÓÒÚ‡ÌÂÌ ËÎË ‰‚ÛÒÚ‡-ÌÂÌ (ÔË 4 Ô‡ˆËÂÌÚ‡) “hip-spine” ÒËÌ‰ÓÏ (Ú‡·Î.1).

èË ‚ÒË˜ÍË Ô‡ˆËÂÌÚË ÒÂ ÛÒÚ‡ÌÓ‚Ë ‚ËÒÓÍ‡ ˜ÂÒÚÓÚ‡ Ì‡ÍÎËÌË˜ÌËÚÂ ÒËÏÔÚÓÏË Á‡ Â‰ÌÓÒÚ‡ÌÂÌ ËÎË ‰‚ÛÒÚ‡ÌÂÌÎÛÏ·ÓÒ‡Í‡ÎÂÌ ‡‰ËÍÛÎËÚ Ë ÍÓÍÒ‡ÚÓÁ‡ Â‰ÌÓ‚ÂÏÂÌÌÓ(n=47 “hip-spine” ÒËÌ‰ÓÏË).

èË 33 (76,7%) Ô‡ˆËÂÌÚË Ò ÂÌ„ÚÂÌÓ„‡ÙËfl Ì‡ Ú‡-Á‡ Ë ÍÓÌÒÛÎÚ‡ˆËfl Ò ÓÚÓÔÂ‰-Ú‡‚Ï‡ÚÓÎÓ„ ÒÂ ÔÓÚ‚˙-‰Ë ‰Ë‡„ÌÓÁ‡Ú‡ ÍÓÍÒ‡ÚÓÁ‡ ‚ Ì‡ÔÂ‰Ì‡Î ÒÚ‡‰ËÈ, Í‡ÚÓÔË 4 (9,3%) ÓÚ Úflı ÍÓÍÒ‡ÚÓÁ‡Ú‡ Â ‰‚ÛÒÚ‡ÌÌ‡;ÔË 6 (13,9%) ÓÚ Ô‡ˆËÂÌÚËÚÂ ÒÛÒÔÂÍˆËflÚ‡ Á‡ Ò˙Ô˙Ú-ÒÚ‚‡˘‡ ÍÓÍÒ‡ÚÓÁ‡ ÌÂ ÒÂ ÔÓÚ‚˙‰Ë, Í‡ÍÚÓ ÓÚÂÌÚ„ÂÌÓ‚ÓÚÓ ËÁÒÎÂ‰‚‡ÌÂ, Ú‡Í‡ Ë ÓÚ ÍÓÌÒÛÎÚ‡ˆËflÚ‡Ò ÓÚÓÔÂ‰-Ú‡‚Ï‡ÚÓÎÓ„; ÔË 4 (9,3%) Ô‡ˆËÂÌÚË Ò Ì‡-˜‡ÎÌ‡ ÍÓÍÒ‡ÚÓÁ‡, Ì‡ ÚÓÁË ÂÚ‡Ô ÂÌ‰ÓÔÓÚÂÁË‡ÌÂ ÌÂÂ ÔÓÍ‡Á‡ÌÓ.

Ç äÎËÌËÍ‡Ú‡ ÔÓ ÓÚÓÔÂ‰Ëfl Ë Ú‡‚Ï‡ÚÓÎÓ„Ëfl Ì‡ ìå-ÅÄã ◊ë‚.ÉÂÓ„Ë”- èÎÓ‚‰Ë‚, ÒÎÂ‰ ËÌÙÓÏË‡ÌÓ Ò˙„Î‡ÒËÂ,ÔË 29 (67,4%) ÓÚ Ô‡ˆËÂÌÚËÚÂ (12 Ï˙ÊÂ Ë 17 ÊÂÌË; ÒÂ‰-Ì‡ ‚˙Á‡ÒÚ 69±4,3 „.), ÒÂ ÔÓ‚Â‰Â ‰‚ÛÔÓÎ˛ÒÌÓ ÂÌ‰ÓÔÓÚÂ-ÁË‡ÌÂ Ì‡ Ú‡ÁÓ·Â‰ÂÌ‡ ÒÚ‡‚‡, Í‡ÚÓ ÔË ‰‚‡ ÓÚ ÒÎÛ˜‡ËÚÂÒ‡ ÔÓ‰ÏÂÌÂÌË ‰‚ÂÚÂ ÒÚ‡‚Ë ‚ ËÌÚÂ‚‡Î ÓÚ 6 ÏÂÒÂˆ‡ ÏÂÊ-ç‡ Ú‡·Î. 2 Ò‡ ÔÂ‰ÒÚ‡‚ÂÌË Ë Ò‡‚ÌÂÌË ÂÁÛÎÚ‡ÚËÚÂ ÓÚÔËÎÓÊÂÌ‡Ú‡ ÇÄë ÔË 29 ÓÚ ÓÔÂË‡ÌËÚÂ Ô‡ˆËÂÌÚË, ÔÓ-ÓÚ‰ÂÎÌÓ Á‡ ÎÛÏ·ÓÒ‡Í‡ÎÌ‡ Ë ËÌ„‚ËÌ‡ÎÌ‡ ·ÓÎÍ‡, ÔÂ‰ÓÔÂ-‡ÚË‚ÌÓ Ë Ì‡ 3 ÏÂÒÂˆ ÒÎÂ‰ ÔÓ‚Â‰ÂÌÓÚÓ ÂÌ‰ÓÔÓÚÂÁË‡-ÌÂ (Ú‡·Î.2).

áÌ‡˜ËÏÓ ÔÓ-‚ËÒÓÍË Ò‡ ÔÓÍ‡Á‡ÚÂÎËÚÂ Ì‡ ÇÄë Á‡ ÓˆÂÌÂ-Ì‡Ú‡ ÔÓ ÒËÎ‡ ËÌ„‚ËÌ‡ÎÌ‡ Ë ÎÛÏ·ÓÒ‡Í‡ÎÌ‡Ú‡ ·ÓÎÍ‡ ÔÂ‰ËÓÔÂ‡ÚË‚ÌÓÚÓ ÎÂ˜ÂÌËÂ, ÓÚ ÚÂÁË ÒÎÂ‰ ÂÌ‰ÓÔÓÚÂÁË‡ÌÂÌ‡ Ú‡ÁÓ·Â‰ÂÌ‡Ú‡ ÒÚ‡‚‡. á‡ ÔÓ‚Â˜ÂÚÓ ÓÔÂË‡ÌË Ô‡ˆËÂÌ-ÚË (n=26; 89,6%) ·ÓÎÍ‡Ú‡ ‚ Ó·Î‡ÒÚÚ‡ Ì‡ ÓÔÂË‡Ì‡-Ú‡(ÚÂ) Ú‡ÁÓ·Â‰ÂÌ‡Ú‡ ÒÚ‡‚‡(Ë) Â Ì‡Ô¸ÎÌÓ ÔÂÓ‰ÓÎflÌ‡, ‡·ÓÎÍ‡Ú‡ ‚ Í˙ÒÚ‡ –ÁÌ‡˜ËÏÓ Ì‡Ï‡ÎflÎ‡.


í‡·Î.1. êÂÁÛÎÚ‡ÚË ÓÚ ÌÂ‚ÓÎÓ„Ë˜ÌËfl ÔÂ„ÎÂ‰

ëËÏÔÚÓÏË Ì‡ ÎÛÏ·ÓÒ‡Í‡ÎÂÌ ÅÓÈ P±Sp ëÛÒÔÂÍÚÌË ÒËÏÔÚÓÏË Ì‡ ÍÓÍÒ‡ÚÓÁ‡ ÅÓÈ P±Sp‡‰ËÍÛÎËÚ Ì‡ıÓ‰ÍË % Ì‡ıÓ‰ÍË %ê‡‰ËÍÛÎÂÌ‡ ·ÓÎÍ‡ ‚ Í˙ÒÚ‡ 47 100 ÅÓÎÍË ‚ ËÎËÓËÌ„‚ËÌ‡ÎÌ‡Ú‡ Ó·Î‡ÒÚ 47 100Ë Ô‡ÂÒÚÂÁËËÑÂÏ‡ÚÓÏÂÌ 39 83.0±5.5 îÂÏÓ‡ÎÌÓ ‡ÁÔÓÒÚ‡ÌÂÌËÂ Ì‡ ·ÓÎÍ‡Ú‡ 42 89.4±4.5ÚËÔ ıËÔÂÒÚÂÁËfl(L3, L4, L5 ËÎË S1)äÓÎflÌÌ‡ ıËÔÓÂÙÎÂÍÒËfl 6 12.8±4.9 ÅÓÎÍ‡ ÔË ÂÍÒÚÂÌÁËfl Ì‡ Í‡Í‡ Ì‡‰ 70° 36 76.6±6.2ÄıËÎÓ‚‡ ıËÔÓÂÙÎÂÍÒËfl 21 44.7±7.3 ç‡ÍÛˆ‚‡˘‡ ÔÓıÓ‰Í‡ 29 61.7±7.1èÓÎÓÊËÚÂÎÌË ‡ÁÒÚÂÊÌË 43 91.5±4.1 èÓÎÓÊËÚÂÎÂÌ ÚÂÒÚ Ì‡ Patrick 37 78.7±6.0ÒËÏÔÚÓÏË Á‡ n. ischiadicusèÓÎÓÊËÚÂÎÂÌ ÚÂÒÚ 6 12,8±4.9 ÅÓÎÍ‡ ‚ ËÔÒËÎ‡ÚÂ‡ÎÌÓÚÓ ÍÓÎflÌÓ 21 44,7±7,3Ì‡ Wassermann

îË„. 1. ê‡ÁÔÂ‰ÂÎÂÌËÂ Ì‡ Ô‡ˆËÂÌÚËÚÂ ÒÔÓÂ‰ ÛÚÓ˜ÌÂÌ‡Ú‡ÌÂ‚ÓÎÓ„Ë˜Ì‡ ‰Ë‡„ÌÓÁ‡

éÅëöÜÑÄçÖ

ä‡ÚÓ Ô‡‚ËÎÓ, ÔË Ô‡ˆËÂÌÚËÚÂ Ò ÍÓÍÒ‡ÚÓÁ‡, ·ÓÎÍË‚ Í˙ÒÚ‡ ÒÂ fl‚fl‚‡Ú, ÍÓ„‡ÚÓ ‰‚ËÊÂÌËflÚ‡ ‚ Ú‡ÁÓ·Â‰ÂÌ‡-Ú‡ ÒÚ‡‚‡ ÒÂ Ó„‡ÌË˜‡Ú Ë ·ÓÎÌËflÚ Ú˙ÒË ÍÓÏÔÂÌÒ‡ˆËfl ÒÂ‰Ì‡ ÔÓ-„ÓÎflÏ‡ ÔÓ‰‚ËÊÌÓÒÚ ‚ Í˙ÒÚÌ‡Ú‡ Ó·Î‡ÒÚ. èÓıÓ‰-Í‡Ú‡ ÒÚ‡‚‡ Ì‡ÍÛˆ‚‡˘‡ Ë Â ÔË˜ËÌ‡ Á‡ ‡ÌÌ‡ ‰ËÒıÓÌ‰ÓÁ‡Ë Á‡ÒËÎ‚‡ÌÂ Ì‡ ÓÔÎ‡Í‚‡ÌËflÚ‡. ç‡ÒÚ˙ÔËÎËÚÂ ÒÚ‡ÚË˜ÌËÌ‡Û¯ÂÌËfl ‚ ÎÛÏ·‡ÎÌ‡Ú‡ Ó·Î‡ÒÚ Ì‡ „˙·Ì‡˜ÌËfl ÒÚ˙Î· Ì‡-ÚÓ‚‡‚‡Ú ÌÂ‡‚ÌÓÏÂÌÓ ‰ËÒÍÓ‚ÂÚÂ Ë ËÌÚÂ‚ÂÚÂ·‡Î-ÌËÚÂ ÒÚ‡‚Ë. ç‡Û¯‡‚‡ ÒÂ ·‡Î‡ÌÒ‡ Ì‡ Ô‡‡‚ÂÚÂ·‡ÎÌËÚÂÏÛÒÍÛÎË - ÔÂ‰ÔÓÒÚ‡‚Í‡ Á‡ ÓÒÚË ·ÓÎÍË ‚ Í˙ÒÚ‡ ÔËËÁ‚˙¯‚‡ÌÂ Ì‡ ÌflÍÓË ‰‚ËÊÂÌËfl. è˙‚ÓÌ‡˜‡ÎÌÓ Ô‡ˆË-ÂÌÚ˙Ú ÏÓÊÂ ‰‡ ·˙‰Â Ì‡ÒÓ˜ÂÌ Í˙Ï ÌÂ‚ÓÎÓ„. äÓ„‡ÚÓ ÌÂ‚-ÓÎÓ„˙Ú Ì‡ÏÂË ‰ÓÒÚ‡Ú˙˜ÌÓ ‰ÓÍ‡Á‡ÚÂÎÒÚ‚‡ Á‡ ‰˙Î„Ó„Ó-‰Ë¯Ì‡ ‰Â„ÂÌÂ‡ÚË‚Ì‡ ÒÔËÌ‡ÎÌ‡ Ô‡ÚÓÎÓ„Ëfl ÔË ÔÓ-‚˙Á‡Ò-ÚÂÌ Ô‡ˆËÂÌÚ Ò ÚÛ‰ÌÓ ÔÓ‚ÎËfl‚‡˘‡ ÒÂ ·ÓÎÍ‡ ÓÚ ◊ÎÛÏ·Ó-Ò‡Í‡ÎÂÌ ‡‰ËÍÛÎËÚ” Ò ÌÓ‚‡ ÔÓ-‚ËÒÓÍ‡ ÎÓÍ‡ÎËÁ‡ˆËfl (L2-L3, L3-L4) Ë ÙÂÏÓ‡ÎÌÓ ‡ÁÔÓÒÚ‡ÌÂÌËÂ, Ò˙ÏÌÂÌËÂÚÓ Á‡“hip-spine” ÒËÌ‰ÓÏ Ì‡Î‡„‡ ÍÓÌÒÛÎÚ‡ÚËÓ‚ÂÌ ÔÂ„ÎÂ‰ ÓÚÓÚÓÔÂ‰-Ú‡‚Ï‡ÚÓÎÓ„. ÄÍÓ ÒÂ ÛÒÚ‡ÌÓ‚flÚ ÍÎËÌË˜ÌË ËÂÌÚ„ÂÌÓ‚Ë ‰‡ÌÌË Ë Á‡ ÍÓÍÒ‡ÚÓÁ‡, ÓÚÓÔÂ‰-Ú‡‚Ï‡ÚÓ-ÎÓ„˙Ú ÒÂ Ò˜ËÚ‡ ‰Î˙ÊÂÌ ‰‡ ÔÂ‰ÛÔÂ‰Ë: ‚ÒÂÍË Ô‡ˆËÂÌÚ Ò·ÓÎÍ‡ ‚ Í˙ÒÚ‡ Úfl·‚‡ ‰‡ ·˙‰Â ËÁÒÎÂ‰‚‡Ì Á‡ ‡ÒËÏÂÚËfl ‚‰˙ÎÊËÌ‡Ú‡ Ì‡ Í‡Í‡ Ë Á‡ Ì‡ÍÎÓÌ Ì‡ Ú‡Á‡ (1).

ç‡ÎË˜ËÂÚÓ Ì‡ ÒËÏÔÚÓÏË ÓÚ ‰‚Â ÏÂÒÚ‡ (·ÓÎÍ‡ ‚ Í˙Ò-Ú‡ Ë ËÌ„‚ËÌ‡ÎÌ‡ Ó·Î‡ÒÚ Â‰ÌÓ‚ÂÏÂÌÌÓ) ‰‡‚‡ Ó·˙Í‚‡˘‡ÍÎËÌË˜Ì‡ Í‡ÚËÌ‡. Ç ÚÂÁË ÒÎÛ˜‡Ë Â Ú‚˙‰Â ‚ÂÓflÚÌÓ ‰‡ÒÂ Í‡Ò‡Â Á‡ “hip-spine” ÒËÌ‰ÓÏ, ÍÓÈÚÓ Á‡ Ô˙‚Ë Ô˙Ú ÓÔËÒ-‚‡Ú Ë ÍÎËÌË˜ÌÓ ‚‡ÎË‰ËÁË‡Ú Offierski Ë MakNab ÔÂÁ1983 „. (6). ëËÌ‰ÓÏ˙Ú ËÁËÒÍ‚‡ ‰ÓÔ˙ÎÌËÚÂÎÌË ËÌÒÚÛ-ÏÂÌÚ‡ÎÌË ËÁÒÎÂ‰‚‡ÌËfl; ÍÓÌÒÛÎÚ‡ˆËfl Ò ÓÚÓÔÂ‰-Ú‡‚Ï‡-ÚÓÎÓ„ Ë ËÁ·Ó Ì‡ ÔËÓËÚÂÚÌÓ ÚÂ‡ÔÂ‚ÚË˜ÌÓ ÔÓ‚Â‰ÂÌËÂ– ‰ËÁ‡ÈÌ, Ò ÍÓÈÚÓ Ò˙Ó·‡ÁËıÏÂ Ì‡¯ÂÚÓ ÔÓÛ˜‚‡ÌÂ. èÓÎÛ-˜ÂÌËÚÂ ÂÁÛÎÚ‡ÚË ËÏ‡Ú ÔÓÚ‚˙‰ËÚÂÎÂÌ ı‡‡ÍÚÂ Ë Ò‡ÒıÓ‰ÌË Ò ÚÂÁË Ì‡ Â‰Ëˆ‡ ‰Û„Ë ‡‚ÚÓË (3, 4). Ç ÁÌ‡˜ËÏ ÓÚ-ÌÓÒËÚÂÎÂÌ ‰flÎ (n=31, 65,9%) ÒÂ ÔÓÎÛ˜Ë ÍÎËÌË˜ÌÓ ÔÓÚ‚˙-Ê‰ÂÌËÂ Ì‡ ‰Ë‡„ÌÓÒÚËˆË‡ÌËÚÂ ‡Ï·ÛÎ‡ÚÓÌÓ “hip-spine”ÒËÌ‰ÓÏË (n=47). éÚ 43 Ô‡ˆËÂÌÚË Ò “hip-spine” ÒËÌ‰ÓÏ,4-Ï‡ (9,3%) ËÏ‡Ú ‰‚ÛÒÚ‡ÌÌ‡ ÍÓÍÒ‡ÚÓÁ‡; ÔË 6 (13,9%) ‰ÓÍ‡Á‡ÚÂÎÒÚ‚‡ Á‡ ÍÓÍÒ‡ÚÓÁ‡ ÌÂ ÒÂ Ì‡ÏË‡Ú. ë¸˘Ë-ÚÂ Ô‡ˆËÂÌÚË ËÏ‡Ú ÂÌÚ„ÂÌÓ„‡ÙÒÍË Ë äí ‰‡ÌÌË Ò‡ÏÓ Á‡‰Â„ÂÌÂ‡ÚË‚Ì‡ Ô‡ÚÓÎÓ„Ëfl Ì‡ „¸·Ì‡˜ÌËfl ÒÚ¸Î· Ì‡ ÌË‚‡L3-L4 (ÔË 2 Ô‡ˆËÂÌÚË) Ë Ì‡ L4-L5 (ÔË 4 Ô‡ˆËÂÌÚ‡). ÑÓ-Í‡ÚÓ ‚ Ô˙‚ËÚÂ 2 ÒÎÛ˜‡fl ÙÂÏÓ‡ÎÌÓÚÓ ‡ÁÔÓÒÚ‡ÌÂÌËÂÌ‡ ·ÓÎÍ‡Ú‡ Â Ó·flÒÌËÏÓ Ò Ì‡ÎË˜Ì‡Ú‡ L4 ‡‰ËÍÛÎÓÔ‡ÚËfl,ÚÓ ÔË ÓÒÚ‡Ì‡ÎËÚÂ 4 ÒÎÛ˜‡fl ÙÂÏo‡ÎÌ‡Ú‡ ·ÓÎÍ‡ ÏÓÊÂ ‰‡Â ÂÁÛÎÚ‡Ú ËÎË Ì‡ ‰ËÒÍÓ‚‡ ‰Â„ÂÌÂ‡ˆËfl Ò ÔÓÚÛÁËfl ËÎËÌ‡ ÌÂ‡ÔÓÙËÁË‡ÎÂÌ ‡ÚËÚ Ò˙Ò ÒËÌÓ‚ËÚ. àÏ‡ ‰‡ÌÌË ÓÚ‰Û„Ë ÔÓÛ˜‚‡ÌËfl, ˜Â ÔË ‡‰ËÍÛÎÓÔ‡ÚËflÚ‡ Ì‡ L4 ÍÓÂÌ-˜Â ÔÓ-˜ÂÒÚÓ ÒÂ ÒÂ˘‡ ÎÂÁËfl Ì‡ ÙÓ‡ÏÂÌ‡ Ì‡ L4-L5, ÓÚÍÓÎ-ÍÓÚÓ Ì‡ L3-L4 ‰ËÒÍÓ‚Ó ÔÓÒÚ‡ÌÒÚ‚Ó (5). Ç ÚÂÁË ÒÎÛ˜‡Ë,Í˙ÒÚÌ‡Ú‡ ·ÓÎÍ‡ Ò ÙÂÏÓ‡ÎÌÓ ‡ÁÔÓÒÚ‡ÌÂÌËÂ, ÔË ÌÂ-„‡ÚË‚ÂÌ ÂÁÛÎÚ‡Ú Á‡ ÍÓÍÒ‡ÚÓÁ‡ (ÓÚ ÂÌÚ„ÂÌÓ„‡ÙËfl-Ú‡ Ì‡ Ú‡Á‡), Â ÓÔ‡‚‰‡Ì‡.

íÂ‡ÔÂ‚ÚË˜ÂÌ ÛÒÔÂı Á‡ ÁÌ‡˜ËÏÓ Ó·ÎÂÍ˜‡‚‡ÌÂ (‰Ó ËÁ˜ÂÁ-‚‡ÌÂ) Ì‡ ·ÓÎÍ‡Ú‡ ‚ Ó·Î‡ÒÚÚ‡ Ì‡ Ú‡ÁÓ·Â‰ÂÌ‡Ú‡ ÒÚ‡‚‡ÒÎÂ‰ ÂÌ‰ÓÔÓÚÂÁË‡ÌÂ (31 Ú‡ÁÓ·Â‰ÂÌË ÒÚ‡‚Ë), ÒÂ ÓÚ˜Â-ÚÂ ÓÚ 28 Ó·Î‡ÒÚË (90,3 %). ÅÓÎÍ‡Ú‡ ‚ Í¸ÒÚ‡ Ì‡Ï‡ÎflÔË 20 (64,5%) ÓÚ ÓÔÂË‡ÌËÚÂ Ô‡ˆËÂÌÚË, ‡ Ò ÌÓÏ‡ÎËÁË-‡ÌÂ Ì‡ ÔÓıÓ‰Í‡Ú‡ Ò‡ 27 (87,1%). ëÎÂ‰Ó‚‡ÚÂÎÌÓ, ÔËÓË-ÚÂÚÌËflÚ ËÁ·Ó Ì‡ ÚÂ‡ÔÂ‚ÚË˜ÌÓ ÔÓ‚Â‰ÂÌËÂ ‚ Ì‡ÒÚÓfl-˘ÂÚÓ ÔÓÛ˜‚‡ÌÂ (ÂÌ‰ÓÔÓÚÂÁË‡ÌÂ Ì‡ Ú‡ÁÓ·Â‰ÂÌ‡Ú‡ÒÚ‡‚‡) ÔË Â¯‡‚‡ÌÂ Ì‡ ËÌÚÂ‰ËÒˆËÔÎËÌ‡ÌËfl ÔÓ·ÎÂÏ◊hip-spine” ÒËÌ‰ÓÏ Â Ô‡‚ËÎÂÌ Ë Â Á‡ÒÎÛÊ‡‚‡Î ‚ÌËÏ‡ÌËÂ,Ú˙È Í‡ÚÓ Ô‡ˆËÂÌÚËÚÂ Ò‡ ÔÓÎÛ˜ËÎË Ò‚ÓÂÚÓ ÔÓ-‰Ó·Ó Í‡-˜ÂÒÚ‚Ó Ì‡ ÊË‚ÓÚ.


Ç Á‡ÍÎ˛˜ÂÌËÂ ÏÓÊÂ ‰‡ ÒÂ Í‡ÊÂ, ˜Â ÂÁÛÎÚ‡ÚËÚÂ ÓÚÌ‡ÒÚÓfl˘ÂÚÓ ÔÓÛ˜‚‡ÌÂ Ò‡ ‰ÓÍ‡Á‡ÚÂÎÒÚ‚Ó Á‡ ÌÂÓ·ıÓ‰Ë-ÏÓÒÚÚ‡ ÔÓÌflÚËÂÚÓ ◊hip-spine” ÒËÌ‰ÓÏ ‰‡ Ì‡‚ÎÂÁÂ ‚ Û-ÚËÌÌ‡Ú‡ Ô‡ÍÚËÍ‡ Ì‡ Ó·˘ÓÔ‡ÍÚËÍÛ‚‡˘Ë ÎÂÍ‡Ë, ÌÂ‚-ÓÎÓÁË Ë ÓÚÓÔÂ‰-Ú‡‚Ï‡ÚÓÎÓÁË, Á‡ ÓÁÌ‡˜‡‚‡ÌÂ Ì‡ ÔËÒ˙-ÒÚ‚‡˘‡Ú‡ ˜ÂÒÚÓ ÔË ÔÓ-‚˙Á‡ÒÚÌËÚÂ Ô‡ˆËÂÌÚË ÍÓÏ·Ë-Ì‡ˆËfl ÓÚ ÒËÏÔÚÓÏË Ì‡ ÎÛÏ·ÓÒ‡Í‡ÎÂÌ ‡‰ËÍÛÎËÚ Ë ÍÓÍ-Ò‡ÚÓÁ‡ Â‰ÌÓ‚ÂÏÂÌÌÓ. é˘Â ‚ ‡Ï·ÛÎ‡ÚÓÌË ÛÒÎÓ‚Ëfl, Á‡‰ËÙÂÂÌˆË‡ÌÂ Ì‡ ÒËÌ‰ÓÏ‡, ÒÂ Ì‡Î‡„‡ ‚ ÌÂ‚ÓÎÓ„Ë˜ÌËflÒÚ‡ÚÛÒ ‰‡ ÌÂ ÒÂ ËÁÔÛÒÍ‡Ú ÔÓ·ËÚÂ, ÔÓÁËÚË‚Ë‡˘Ë ·ÓÎÂ-ÒÚÌÓ Û‚ÂÊ‰‡ÌÂ Ì‡ Ú‡ÁÓ·Â‰ÂÌ‡Ú‡ ÒÚ‡‚‡; ‰‡ ÒÂ Ì‡Ô‡‚ËÂÌÚ„ÂÌÓ„‡ÙËfl Ì‡ Ú‡Á‡ Ë ‰‡ ÒÂ ÔÓ‚Â‰Â ÍÓÌÒÛÎÚ‡ˆËfl ÒÓÚÓÔÂ‰-Ú‡‚Ï‡ÚÓÎÓ„. èË Ì‡ÎË˜ËÂ Ì‡ ÍÓÍÒ‡ÚÓÁ‡ ‚Ì‡ÔÂ‰Ì‡Î ÒÚ‡‰ËÈ, ÔËÓËÚÂÚÌËflÚ ËÁ·Ó Ì‡ ËÌ‚‡ÁË‚ÌÓÎÂ˜ÂÌËÂ – ÂÌ‰ÓÔÓÚÂÁË‡ÌÂ Ì‡ ËÌ‰ËˆË‡Ì‡Ú‡ Ú‡ÁÓ·Â‰Â-Ì‡ ÒÚ‡‚‡, ÔÓÁ‚ÓÎfl‚‡ ÁÌ‡˜ËÏÓ Ó·ÎÂÍ˜‡‚‡ÌÂ Ì‡ ·ÓÎÍ‡Ú‡ Ë ‚‰‚ÂÚÂ Ó·Î‡ÒÚË (ËÌ„‚ËÌ‡ÎÌ‡ Ë ÎÛÏ·Ó-Ò‡Í‡ÎÌ‡) Ë ÌÓÏ‡ÎË-ÁË‡ÌÂ Ì‡ Ì‡Û¯ÂÌ‡Ú‡ ÔÓıÓ‰Í‡ ‚˙‚ ‚ËÒÓÍ ÓÚÌÓÒËÚÂÎÂÌ‰flÎ ÓÚ Ô‡ˆËÂÌÚËÚÂ, Ô˙‚ÓÌ‡˜‡ÎÌÓ ‰Ë‡„ÌÓÒÚËˆË‡ÌË Í‡-ÚÓ ◊hip-spine” ÒËÌ‰ÓÏ.

ë‡ÏÓ ÔË ÌÂÁÌ‡˜ËÏ ‰flÎ ÓÚ Ô‡ˆËÂÌÚË Ò ◊hip-spine”ÒËÌ‰ÓÏ ÒÛÒÔÂÍˆËflÚ‡ Á‡ ÍÓÍÒ‡ÚÓÁ‡ ÌÂ ÒÂ ÔÓÚ‚˙‰Ë. ÇÚÂÁË ÒÎÛ˜‡Ë Ò˙Ô˙ÚÒÚ‚‡˘ËÚÂ „Û·Ë ‰Â„ÂÌÂ‡ÚË‚ÌË ÔÓ-ÏÂÌË ‚ ÎÛÏ·‡ÎÌËfl „˙·Ì‡Í Ò ‡‰ËÍÛÎÓÔ‡ÚËË Ì‡ ÔÓ-‚ËÒÓÍÓÌË‚Ó (L3, L4), Ó·ÛÒÎ‡‚flÚ ÌÂÒÚ‡Ì‰‡ÚÌÓÚÓ (ÙÂÏÓ‡ÎÌÓ, ‡ÌÂ Ë¯Ë‡Î„Ë˜ÌÓ) ‡ÁÔÓÒÚ‡ÌÂÌËÂ Ì‡ Í˙ÒÚÌ‡Ú‡ ·ÓÎÍ‡.

ãàíÖêÄíìêÄ1. äÓÒÚ‡‰ËÌÓ‚, Ñ. ÅÓÎÍË ‚ „˙·‡ Ë Í˙ÒÚ‡: ‰Ë‡„ÌÓÁ‡, ÎÂ˜ÂÌËÂ, ÔÂ‰Ô‡Á‚‡ÌÂ.

åËÍÓÔËÌÚËÌ„, ëÓÙËfl, 1999, 68-692. åËÎ‡ÌÓ‚, à. ÅÓÎÍË ‚ „˙·‡, ëÓÙËfl, 2002, 72-733. Ben-Galim P, Ben-Galim T, Rand, N, et al. Hip-spine syndrome: the effect of

total hip replacement surgery on low back pain in severe osteoarthritis of thehip. Spine, 32, 2007, 19, 2099-2102

4. Fogel GR, Esses SI. Hip spine syndrome: management of coexisting radicu-lopathy and arthritis of the lower extremity. Spine, 3, 2003, 238-241

5. Hazlett JW. Low back pain with femoral neuritis. Clin Orthop Relat Res,1975, 108, 19-26

6. Offierski CM, MacNab I. Hip-spine syndrome. Spine, 8, 1983, 3, 316-321

Ä‰ÂÒ Á‡ ÍÓÂÒÔÓÌ‰ÂÌˆËfl:Ñ- èÂÌÍ‡ Ä. ÄÚ‡Ì‡ÒÓ‚‡, ‰.Ï.ÉÎ‡‚ÂÌ ‡ÒËÒÚÂÌÚäÎËÌËÍ‡ ÔÓ ÌÂ‚ÓÎÓ„ËflåÂ‰ËˆËÌÒÍË ìÌË‚ÂÒËÚÂÚÅÛÎ. ◊Ç‡ÒËÎ ÄÔËÎÓ‚” 15ÄèÎÓ‚‰Ë‚ 4000íÂÎ: 0888 837 352, 032 649 939î‡ÍÒ: 032 649 939E-mail: [email protected]


í‡·Î. 2. êÂÁÛÎÚ‡ÚË ÓÚ ÔËÎÓÊÂÌ‡Ú‡ ÇÄë ÔË ÓÔÂË‡ÌËÚÂ Ô‡ˆËÂÌÚË

ëËÏÔÚÓÏË èÂËÓ‰Ë P±Sp u êuÅÓÎÍË ‚ Í˙ÒÚ‡ èÂ‰Ë ÂÌ‰ÓÔÓÚÂÁË‡ÌÂ 6.6 ± 1.1 3.3 <0.01

ëÎÂ‰ ÂÌ‰ÓÔÓÚÂÁË‡ÌÂ 2.6 ± 0.4ÅÓÎÍË ‚ ËÎËÓ- èÂ‰Ë ÂÌ‰ÓÔÓÚÂÁË‡ÌÂ 7.2 ± 0.7 5.9 <0.001ËÌ„‚ËÌ‡ÎÌ‡Ú‡ ëÎÂ‰ ÂÌ‰ÓÔÓÚÂÁË‡ÌÂ 2.4 ± 0.4Ó·Î‡ÒÚ

SUMMARY

EARLY POSTOPERATIVE PROPHYLACTIC ANTICONVULSANT TREATMENT WITH DEPAKINE

CHRONO IN BRAIN TUMOR PATIENTSY. Panov, R Kalpatchi

The medical treatment of epilepsy in brain tumor patients hasmainly been studied, and the optimal management of seizures withantiepileptic drugs is unclear. Enzyme-inducing anticonvulsants aregenerally not recommended because they can lead to insufficientserum levels of concomitantly administered chemotherapeuticdrugs and corticosteroids. Valproic acid is an enzyme inhibitor andmay be used in the neurosurgical setting in the prevention ofseizures in brain tumor patients.

We analyzed the data related to 94 patients harbouring supra-tentorial brain tumors with the aim to assess the efficacy ofdepakine chrono in preventing the occurrence or the recurrence ofearly postoperative seizures. Menigeomas were observed in 48patients. Glial cell tumors were observed in 46 patients. Seizureswere documented in 24 patients (26%) before operation.Generalised tonic-clonic seizures were the most common. Afteroperation persistent symptomatic seizures never occurred. We didnot observe incidence of pharmacological interactions and adverseeffects. Our data showed that Valproate is efficacious, and shouldremain the drug of first choice for patients with brain tumors.

KEY WORDS: brain tumor, seizure, valproate, depakine chrono.

êÖáûåÖ

åÂ‰ËÍ‡ÏÂÌÚÓÁÌÓÚÓ ÎÂ˜ÂÌËÂ Ì‡ ÂÔËÎÂÔÒËflÚ‡ ÔË ·ÓÎÌË ÒÏÓÁ˙˜ÌË ÚÛÏÓË ÌÂ Â ‰ÓÒÚ‡Ú˙˜ÌÓ ÔÓÛ˜ÂÌÓ. çflÏ‡ Â‰ËÌÌÓÒÚ‡ÌÓ‚Ë˘Â Á‡ ÓÔÚËÏ‡ÎÌÓÚÓ ÚÂÚË‡ÌÂ Ì‡ ÂÔËÎÂÔÚË˜ÌËÚÂÔËÒÚ˙ÔË. ÖÌÁËÏ-ËÌ‰ÛˆË‡˘ËÚÂ ‡ÌÚËÍÓÌ‚ÛÎÒ‡ÌÚË ÌÂ ÒÂÔÂÔÓ˙˜‚‡Ú, Ú˙È Í‡ÚÓ Ì‡Ï‡Îfl‚‡Ú ÒÂÛÏÌÓÚÓ ÌË‚Ó Ì‡ ıË-ÏËÓÚÂ‡ÔÂ‚ÚËˆË Ë ÍÓÚËÍÓÒÚÂÓË‰Ë. Ç‡ÎÔÓÂ‚‡Ú‡ ÍËÒÂÎË-Ì‡ Â ÂÌÁËÏÂÌ ËÌıË·ËÚÓ Ë ·Ë ÏÓ„Î‡ ‰‡ ·˙‰Â ËÁÔÓÎÁ‚‡Ì‡ ‚ ÌÂ‚-ÓıËÛ„Ë˜Ì‡Ú‡ Ô‡ÍÚËÍ‡. èÓÒÎÂ‰ÂÌË Ò‡ 94 Ô‡ˆËÂÌÚË Ò˙ÒÒÛÔ‡ÚÂÌÚÓË‡ÎÌË ÏÓÁ˙˜ÌË ÚÛÏÓË, ÔË ÍÓËÚÓ Â ÔÓ‚Â‰ÂÌ‡ÔÓÙËÎ‡ÍÚËÍ‡ Ë ÎÂ˜ÂÌËÂ Ì‡ ‡ÌÌËÚÂ ÒÎÂ‰ÓÔÂ‡ÚË‚ÌË ÂÔË-ÎÂÔÚË˜ÌË ÔËÒÚ˙ÔË Ò ÑÂÔ‡ÍËÌ ıÓÌÓ, Ò ˆÂÎ ‰‡ ÒÂ ÛÒÚ‡ÌÓ‚Ë‰ÓÍÓÎÍÓ ÚÓÁË ÏÂ‰ËÍ‡ÏÂÌÚ Â ÂÙËÍ‡ÒÂÌ. éÚ Úflı – 48 ‰Û¯Ë Ò‡Ò ÏÂÌËÌ„ÂÓÏË Ë 46 ‰Û¯Ë Ò ıÂÏËÒÙÂË‡ÎÌË „ÎËÓÏË Ò ‡ÁÎË˜Ì‡ÒÚÂÔÂÌ Ì‡ Ï‡ÎË„ÌËÚÂÚ. Ñ‚‡‰ÂÒÂÚ Ë ˜ÂÚËË ·ÓÎÌË- 26% Ò‡ËÏ‡ÎË ÂÔËÎÂÔÚË˜ÌË ÔËÒÚ˙ÔË ÔÂ‰ÓÔÂ‡ÚË‚ÌÓ. ÉÂÌÂ‡ÎËÁË-‡ÌËÚÂ ÚÓÌË˜ÌÓ-ÍÎÓÌË˜ÌË ÔËÒÚ˙ÔË Ò‡ Ì‡È-˜ÂÒÚË. ëÎÂ‰ÓÔÂ-‡ÚË‚ÌÓ ÌÂ Ò‡ ÛÒÚ‡ÌÓ‚ÂÌË ÍÎËÌË˜ÌÓ ÔÓfl‚ÂÌË ÂÔËÎÂÔÚË˜ÌËÔËÒÚ˙ÔË. çÂ Ò‡ ÛÒÚ‡ÌÓ‚ÂÌË ÌÂÊÂÎ‡ÌË Ù‡Ï‡ÍÓÎÓ„Ë˜ÌË ‚Á‡-ËÏÓ‰ÂÈÒÚ‚Ëfl ËÎË ÒÚ‡ÌË˜ÌË ÂÙÂÍÚË Ì‡ ÏÂ‰ËÍ‡ÏÂÌÚ‡. ç‡-¯ËÚÂ ‰‡ÌÌË ÔÓÍ‡Á‚‡Ú, ˜Â ‚‡ÎÔÓ‡Ú˙Ú Â ÂÙËÍ‡ÒÂÌ Ë ÏÓÊÂ ‰‡·˙‰Â ÏÂ‰ËÍ‡ÏÂÌÚ Ì‡ ËÁ·Ó ÔË ·ÓÎÌË Ò ÏÓÁ˙˜ÌË ÚÛÏÓË.

äãûóéÇà Ñìåà: ÏÓÁ˙˜ÂÌ ÚÛÏÓ, ÂÔËÎÂÔÚË˜ÂÌÔËÒÚ˙Ô, ‚‡ÎÔÓ‡Ú, ‰ÂÔ‡ÍËÌ ıÓÌÓ.

ÖÔËÎÂÔÚË˜ÌËÚÂ ÔËÒÚ˙ÔË ˜ÂÒÚÓ ÛÚÂÊÌfl‚‡Ú Ò˙ÒÚÓflÌË-ÂÚÓ Ì‡ ÓÔÂË‡ÌË Ë ÌÂÓÔÂË‡ÌË ·ÓÎÌË Ò ÏÓÁ˙˜ÌË ÚÛÏÓË.èÓÌflÍÓ„‡ ÂÔËÎÂÔÚË˜ÌËÚÂ ÔËÒÚ˙ÔË Ò‡ Ô˙‚ Ë Â‰ËÌÒÚ‚ÂÌÒËÏÔÚÓÏ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ, ÌÓ ÏÓ„‡Ú ‰‡ ÒÂ ÔÓfl‚flÚ Ë ‚ Ì‡È-ÍËÚË˜ÌËfl ‡ÌÂÌ ÒÎÂ‰ÓÔÂ‡ÚË‚ÂÌ ÔÂËÓ‰. èÓÚË‚ÓÂ˜Ë‚Ë

Ò‡ ÒÚ‡ÌÓ‚Ë˘‡Ú‡ Á‡ ÔÓÙËÎ‡ÍÚË˜Ì‡Ú‡ ÛÔÓÚÂ·‡ Ì‡ ÔÓÚË-‚ÓÂÔËÎÂÔÚË˜ÌË ÏÂ‰ËÍ‡ÏÂÌÚË ÒÎÂ‰ÓÔÂ‡ÚË‚ÌÓ. é·˙˘‡ ÒÂ‚ÌËÏ‡ÌËÂ Ì‡ ÒÚ‡ÌË˜ÌËÚÂ ËÏ ‰ÂÈÒÚ‚Ëfl, Í‡ÍÚÓ Ë Ì‡ ÔÓÚÂÌ-ˆË‡ÎÌËÚÂ ËÏ ‚Á‡ËÏÓ‰ÂÈÒÚ‚Ëfl Ò ÍÓÚËÍÓÒÚÂÓË‰Ë Ë ıËÏËÓ-ÚÂ‡ÔÂ‚ÚËˆË. ÑÓÍ‡ÚÓ ÂÌÁËÏ-ËÌ‰ÛˆË‡˘ËÚÂ ÔÓÚË‚ÓÂÔË-ÎÂÔÚË˜ÌË ÏÂ‰ËÍ‡ÏÂÌÚË ÔÓ‰ÚËÒÍ‡Ú ÂÙÂÍÚ‡ ËÏ, ÂÌÁËÏ-ËÌ-ıË·Ë‡˘ËÚÂ ÏÂ‰ËÍ‡ÏÂÌÚË, Í‡ÚÓ ‚‡ÎÔÓ‡Ú‡, ÔÓ-ÒÍÓÓ „ÓÔÓÚÂÌˆËË‡Ú.

ñÖã

Ñ‡ ÒÂ ÛÒÚ‡ÌÓ‚Ë ÂÙÂÍÚË‚ÌÓÒÚÚ‡ Ì‡ ‡ÌÌ‡Ú‡ ÔÓÒÚÓÔÂ‡-ÚË‚Ì‡ ÔÓÙËÎ‡ÍÚËÍ‡ Ì‡ ÂÔËÎÂÔÚË˜ÌË ÔËÒÚ˙ÔË Ò Depakinechrono ÔË ·ÓÎÌË Ò ÏÓÁ˙˜ÌË ÚÛÏÓË.

åÄíÖêàÄã à åÖíéÑ

èÓÒÎÂ‰ÂÌË Ò‡ 94 ·ÓÎÌË Ò ÏÓÁ˙˜ÌË ÚÛÏÓË ÔÓÒÚ˙ÔËÎË Ì‡ÎÂ˜ÂÌËÂ ‚ ÌÂ‚ÓıËÛ„Ë˜ÌË ÍÎËÌËÍË ‚ ìÌË‚ÂÒËÚÂÚÒÍ‡ ·ÓÎ-ÌËˆ‡- „‡‰ íÛ, î‡ÌˆËfl, Ë ìÌË‚ÂÒËÚÂÚÒÍ‡ ÄÎÂÍÒ‡Ì‰Ó‚Ò-Í‡ ·ÓÎÌËˆ‡.- ëÓÙËfl. éÚ Úflı – 48 ‰Û¯Ë Ò‡ Ò ÏÂÌËÌ„ÂÓÏË Ë 46‰Û¯Ë Ò ıÂÏËÒÙÂË‡ÎÌË „ÎËÓÏË Ò ‡ÁÎË˜Ì‡ ÒÚÂÔÂÌ Ì‡ Ï‡ÎË„ÌË-ÚÂÚ. ÑË‡„ÌÓÁËÚÂ Ò‡ ÔÓÒÚ‡‚ÂÌË Ò ÍÓÏÔ˛Ú˙Ì‡ ÚÓÏÓ„‡ÙËflËÎË fl‰ÂÌ Ï‡„ÌËÚÂÌ ÂÁÓÌ‡ÌÒ. çflÏ‡ ‡ÁÎËÍ‡ ‚ ÔÂ‰ÓÔÂ‡-ÚË‚Ì‡Ú‡ ÔÓ‰„ÓÚÓ‚Í‡ Ì‡ ·ÓÎÌËÚÂ ‚ ‰‚ÂÚÂ ÍÎËÌËÍË, Í‡ÍÚÓ Ë‚ ÓÔÂ‡ÚË‚Ì‡Ú‡ ÚÂıÌËÍ‡, ÓÒ‚ÂÌ ‚ ÔÓ-‡‰ËÍ‡ÎÌÓÚÓ ÔÓ‚Â‰Â-ÌËÂ ÔË ÔÓÎ˛ÒÌË ÚÛÏÓË ‚ ÌÂ‚ÓıËÛ„Ë˜Ì‡ ÍÎËÌËÍ‡ „‡‰íÛ - ÎÓ·ÂÍÚÓÏËfl. ïËÒÚÓÎÓ„Ë˜Ì‡Ú‡ ‚ÂËÙËÍ‡ˆËfl Â ÒÔÓÂ‰ıËÒÚÓÎÓ„Ë˜Ì‡Ú‡ ÍÎ‡ÒËÙËÍ‡ˆËfl Ì‡ ÚÛÏÓËÚÂ Ì‡ ñçë (ëáé,2000). Ñ‚‡‰ÂÒÂÚ Ë ˜ÂÚËË ·ÓÎÌË- 26% Ò‡ ËÏ‡ÎË ÂÔËÎÂÔÚË˜-ÌË ÔËÒÚ˙ÔË ÔÂ‰ÓÔÂ‡ÚË‚ÌÓ. èË ‰‚‡‰ÂÒÂÚ Ë ‰‚‡Ï‡ Ò‡ Ì‡·-Î˛‰‡‚‡ÌË „ÂÌÂ‡ÎËÁË‡ÌË ËÎË ‚ÚÓË˜ÌÓ „ÂÌÂ‡ÎËÁË‡ÌË ÂÔË-ÎÂÔÚË˜ÌË ÔËÒÚ˙ÔË. èË ‰‚‡Ï‡ Ò‡ ÛÒÚ‡ÌÓ‚ÂÌË Ô‡ˆË‡ÎÌËÂÔËÎÂÔÚË˜ÌË ÔËÒÚ˙ÔË. ä‡ÍÚÓ ÔÂ‰ÓÔÂ‡ÚË‚ÌÓ Ú‡Í‡ Ë ÒÎÂ-‰ÓÔÂ‡ÚË‚ÌÓ ‚ÒË˜ÍË ·ÓÎÌË Ò‡ ·ËÎË ‚ Ò˙ÁÌ‡ÌËÂ, Ì‡ ÒÓ·ÒÚ‚ÂÌÓ‰Ë¯‡ÌÂ, ÔÂ‚Â‰ÂÌË ‚ ÍÎËÌËÍ‡Ú‡ ÓÚ Â‡ÌËÏ‡ˆËfl Ì‡ ÒÎÂ‰‚‡-˘Ëfl ÓÔÂ‡ÚË‚ÂÌ ‰ÂÌ. Ç „ÛÔËÚÂ ÌÂ Ò‡ ‚ÍÎ˛˜ÂÌË ·ÓÎÌË ÒÚÂÊÍÓ ÒÎÂ‰ÓÔÂ‡ÚË‚ÌÓ ÔÓÚË˜‡ÌÂ, ÍÓÂÚÓ Â Ì‡Î‡„‡ÎÓÔÓ‰˙ÎÊËÚÂÎÌ‡ ËÁÍÛÒÚ‚ÂÌ‡ ·ÂÎÓ‰Ó·Ì‡ ‚ÂÌÚËÎ‡ˆËfl. Ç Ì‡È-ÍËÚË˜ÌËÚÂ Ô˙‚Ë 10 ‰ÌË ÒÎÂ‰ ÓÔÂ‡ˆËflÚ‡ Â ÔÓ‚Â‰ÂÌ‡ ÔÓ-ÙËÎ‡ÍÚËÍ‡ Ì‡ ÂÔËÎÂÔÚË˜ÌË ÔËÒÚ˙ÔË Ò Depakine ëhrono 500mg – ‰‚‡ Ô˙ÚË ‰ÌÂ‚ÌÓ. ÑÓÔ˙ÎÌËÚÂÎÌÓ Â ÔËÎ‡„‡ÌÓ ÔÓÚË‚Ó-ÓÚÓ˜ÌÓ ( ÍÓÚËÍÓÒÚÂÓË‰Ë Ë Ï‡ÌËÚÓÎ ) Ë ‡Ì‡Î„ÂÚË˜ÌÓ ÎÂ˜Â-ÌËÂ. èÓ‚ÂÊ‰‡Ì‡ Â Á‡‰˙ÎÊËÚÂÎÌ‡ ÔÓÙËÎ‡ÍÚËÍ‡ Ò ç2 ·ÎÓ-ÍÂ. ÅÓÎÌËÚÂ Ò‡ ·ËÎË ÔÓ‰ ÌÂÔÂÍ˙ÒÌ‡ÚÓ Ó·˘ÓÒÓÏ‡ÚË˜ÌÓ ËÌÂ‚ÓıËÛ„Ë˜ÌÓ Ì‡·Î˛‰ÂÌËÂ. ã‡·Ó‡ÚÓÂÌ ‡Ì‡ÎËÁ Ì‡ Í˙‚ÌËÔÓÍ‡Á‡ÚÂÎË ‚ÍÎ˛˜ËÚÂÎÌÓ ÔÓÍ‡Á‡ÚÂÎË Á‡ ˜ÂÌÓ‰Ó·Ì‡ Ë ·˙·-Â˜Ì‡ ÙÛÌÍˆËfl Ò‡ ÓÒ˙˘ÂÒÚ‚ÂÌË ÔÂ‰ Ë ÒÎÂ‰ÓÔÂ‡ÚË‚ÌÓ.

êÖáìãíÄíà

åÂÌËÌ„ÂÓÏËÚÂ Ò‡ ÓÚÒÚ‡ÌÂÌË Ï‡ÍÓÒÍÓÔÒÍË ˆflÎÓÒÚÌÓ,Ò ËÁÍÎ˛˜ÂÌËÂ Ì‡ 5 ÒÎÛ˜‡fl Ò ·‡Á‡ÎÌ‡ ÎÓÍ‡ÎËÁ‡ˆËfl. ÉÎËÓÏËÚÂ Ò‡ÓÚÒÚ‡ÌÂÌË ˜‡ÒÚË˜ÌÓ, Ò ËÁÍÎ˛˜ÂÌËÂ Ì‡ 6 ÒÎÛ˜‡fl Ò ÔÓÎ˛ÒÌË„ÎËÓÏË, ÔË ÍÓËÚÓ Â ËÁ‚˙¯ÂÌ‡ ÎÓ·ÂÍÚÓÏËfl Ò ˆflÎÓÒÚÌÓÓÚÒÚ‡Ìfl‚‡ÌÂ Ì‡ ÚÛÏÓ‡ - ‚ 2 ÒÎÛ˜‡fl ÓÚ Úflı Â ÓÒ˙˘ÂÒÚ‚Â-Ì‡ ÙÓÌÚ‡ÎÌ‡ ÎÓ·ÂÍÚÓÏËfl, ÔË 1 ·ÓÎÂÌ Â Ì‡Ô‡‚ÂÌ‡ ÓÍˆËÔË-Ú‡ÎÌ‡ ÎÓ·ÂÍÚÓÏËfl Ë ÔË 3 ·ÓÎÌË- ÚÂÏÔÓ‡ÎÌ‡. çÂÁ‡‚ËÒËÏÓ


éË„ËÌ‡ÎÌË ÒÚ‡ÚËËêÄççÄ èéëíéèÖêÄíàÇçÄ èêéîàãÄäíàäÄ

çÄ ÖèàãÖèíàóçà èêàëíöèà ë DEPAKINÖ CHRONO èêà Åéãçà ë åéáöóçà íìåéêà

â. è‡ÌÓ‚, ê. ä‡ÎÔ‡˜ÍË1

äÎËÌËÍ‡ ÔÓ ÌÂ‚ÓıËÛ„Ëfl, ìÅ “ñ‡Ëˆ‡ âÓ‡ÌÌ‡” ëÓÙËfl1éÚ‰ÂÎÂÌËÂ ÔÓ ÌÂ‚ÓÎÓ„Ëfl, II É‡‰ÒÍ‡ ·ÓÎÌËˆ‡, ëÓÙËfl

ÓÚ ‚Ë‰‡ Ì‡ ÚÛÏÓ‡, ÒÚÂÔÂÌ Ì‡ ÁÎÓÍ‡˜ÂÒÚ‚ÂÌÓÒÚ ËÎË ÎÓÍ‡ÎË-Á‡ˆËfl, ÂÔËÎÂÔÚË˜ÌË ÔËÒÚ˙ÔË ÌÂ Ò‡ Â„ËÒÚË‡ÌË ‚ ÌËÚÓÂ‰ËÌ ÓÚ ÒÎÛ˜‡ËÚÂ Á‡ ‰ÂÒÂÚ ‰ÌÂ‚ÌËfl ÔÂËÓ‰ Ì‡ Ì‡·Î˛‰ÂÌËÂ.çÂ Ò‡ Ì‡·Î˛‰‡‚‡ÌË ÒÚ‡ÌË˜ÌË ÂÙÂÍÚË Ì‡ ÏÂ‰ËÍ‡ÏÂÌÚ‡.

éÅëöÜÑÄçÖ

ç‡·Î˛‰ÂÌËflÚ‡ Ò‡ ÓÒ˙˘ÂÒÚ‚ÂÌË ‚ ‰‚Â ÌÂ‚ÓıËÛ„Ë˜ÌËÍÎËÌËÍË– Â‰Ì‡ ‚˙‚ î‡ÌˆËfl Ë Â‰Ì‡ ‚ Å˙Î„‡Ëfl. çflÏ‡ Ò˙˘Â-ÒÚ‚ÂÌË ‡ÁÎË˜Ëfl ‚ ÂÚ‡ÔËÚÂ Ì‡ ÔÓÒÚ‡‚flÌÂ Ì‡ ‰Ë‡„ÌÓÁ‡Ú‡,ÔÂ‰ÓÔÂ‡ÚË‚Ì‡Ú‡ ÔÓ‰„ÓÚÓ‚Í‡, ÓÔÂ‡ÚË‚Ì‡Ú‡ ÚÂıÌËÍ‡ Ë‚Ó‰ÂÌÂÚÓ Ì‡ ÒÎÂ‰ÓÔÂ‡ÚË‚ÌËfl ÔÂËÓ‰. çflÏ‡ ÒÚ‡ÚËÒÚË˜ÂÒ-ÍË ÁÌ‡˜ËÏ‡ ‡ÁÎËÍ‡ ‚˙‚ ‚Ë‰‡ Ë ÚÂÊÂÒÚÚ‡ Ì‡ ÂÔËÎÂÔÚË˜ÌËÚÂÔËÒÚ˙ÔË ÒÔÓÂ‰ ÎÓÍ‡ÎËÁ‡ˆËflÚ‡ ËÎË ıËÒÚÓÎÓ„Ë˜ÌËfl ‚Ë‰ Ì‡ÚÛÏÓ‡ (10). á‡ÚÓ‚‡ ÒÏÂ ÔÂ‰ÒÚ‡‚ËÎË Ë Ì‡¯ËÚÂ ·ÓÎÌË ‚ Â‰-Ì‡ „ÛÔ‡, ÔÓ‚ÂÊ‰‡˘‡ Â‰Ì‡Í‚Ó ÔÓÚË‚ÓÂÔËÎÂÔÚË˜ÌÓ ÎÂ˜Â-ÌËÂ. ÇÒÂ Ó˘Â ÌflÏ‡ ÒË„ÛÌË ÎËÚÂ‡ÚÛÌË ‰‡ÌÌË Á‡ ÂÙËÍ‡ÒÚ-ÌÓÒÚÚ‡, Ì‡ ÍÓÂÚÓ Ë ‰‡ Â ÔÓÚË‚ÓÂÔËÎÂÔÚË˜ÌÓ ÒÂ‰ÒÚ‚Ó ‚ÔÂ‚ÂÌˆËflÚ‡ Ì‡ ÔÓÒÚÓÔÂ‡ÚË‚Ì‡Ú‡ ÂÔËÎÂÔÒËfl, ‚˙ÔÂÍËÏÌÓ„Ó·ÓÈÌËÚÂ, Í‡ÍÚÓ ÂÍÒÔÂËÏÂÌÚ‡ÎÌË, Ú‡Í‡ Ë ÍÎËÌË˜ÌËËÁÒÎÂ‰‚‡ÌËfl ë‡‚Ìfl‚‡Ú ÒÂ Í‡˜ÂÒÚ‚‡Ú‡ Ì‡ ÏÂ‰ËÍ‡ÏÂÌÚËÚÂË ÚÂıÌËÚÂ ÒÚ‡ÌË˜ÌË ‰ÂÈÒÚ‚Ëfl, ‚Ë‰Ó‚Â ÂÔËÎÂÔÚË˜ÌËÔËÒÚ˙ÔË, ÍÓËÚÓ ÔÓ‚ÎËfl‚‡Ú. ëÔÓÂ‰ ÚÓ‚‡ ÏÓÊÂ ‰‡ ÒÂ Ì‡Ô-‡‚Ë ËÁ·Ó Ì‡ Ô˙‚Ë ÏÂ‰ËÍ‡ÏÂÌÚ. ÅÓÎÌËÚÂ Ò ÏÓÁ˙˜ÌË ÚÛÏÓ-Ë ÌÂ Ô‡‚flÚ ËÁÍÎ˛˜ÂÌËÂ. ÉÛÔ‡ ÓÚ 716 Ô‡ˆËÂÌÚË (5), Ò „ÂÌÂ-‡ÎËÁË‡Ì‡ Ë ÌÂÍÎ‡ÒËÙËˆË‡Ì‡ ÂÔËÎÂÔÒËfl Ò‡ ÔÓÒÎÂ‰ÂÌË 5 „Ó-‰ËÌË. èÓÎÛ˜ÂÌË Ò‡ ÒÚ‡ÚËÒÚË˜ÂÒÍË ‰ÓÒÚÓ‚ÂÌÓ ÔÓ-‰Ó·Ë Â-ÁÛÎÚ‡ÚË ÔË ÎÂ˜ÂÌËÂ Ò ‚‡ÎÔÓ‡Ú. ëÔÓÂ‰ ‡‚ÚÓËÚÂ ÚÓÁËÏÂ‰ËÍ‡ÏÂÌÚ ÔÓ-‰Ó·Â ÒÂ ÔÓÌ‡Òfl ÓÚ ÚÓÔË‡Ï‡Ú Ë Â ÔÓ-ÂÙË-Í‡ÒÂÌ ÓÚ Î‡ÏÓÚËÊËÌ. í‡Í‡ ÒÂ Ì‡Î‡„‡ Í‡ÚÓ Ô˙‚Ó ÒÂ‰ÒÚ‚ÓÌ‡ ËÁ·Ó ÔË „ÂÌÂ‡ÎËÁË‡Ì‡ Ë ÌÂÍÎ‡ÒËÙËˆË‡Ì‡ ÂÔËÎÂÔÒËfl.èÓ ‰‡ÌÌË Ì‡ ‰‚ÓÈÌÓ ÒÎflÔÓ ÔÓÛ˜‚‡ÌÂ Á‡ Ò‡‚Ìfl‚‡ÌÂ Ì‡ ÂÙÂÍ-ÚË‚ÌÓÒÚÚ‡ Ì‡ ÙÂÌËÚÓËÌ Ë ‚‡ÎÔÓ‡Ú ÔË ·ÓÎÌË ÔÂÊË‚ÂÎËÍ‡ÌËÓÚÓÏËfl ÒÂ ÛÒÚ‡ÌÓ‚fl‚fl ÒıÓ‰Ì‡ ÂÙÂÍÚË‚ÌÓÒÚ Ì‡ ‰‚‡Ú‡ÏÂ‰ËÍ‡ÏÂÌÚ‡, ÌÓ ·ÓflÚ Ì‡ ÔÂÍ˙ÒÌ‡ÎËÚÂ ÎÂ˜ÂÌËÂÚÓ ÔÓ‡‰ËÒÚ‡ÌË˜ÌË ÂÙÂÍÚË Ì‡ ÙÂÌËÚÓËÌ‡ Â ·ËÎ 2,5 Ô˙ÚË ÔÓ-„ÓÎflÏ. Ç„ÛÔ‡Ú‡ ÌÂ Â ËÏ‡ÎÓ Ô‡ˆËÂÌÚË Ò ˜ÂÌÓ‰Ó·ÌÓ Á‡·ÓÎfl‚‡ÌÂ ‚Ì‡ÔÂ‰Ì‡Î ÒÚ‡‰ËÈ. ç‡ Ò˙˘ÓÚÓ ÒÚ‡ÌÓ‚Ë˘Â Â Ë (3). Ç‡ÎÔÓ-‡Ú˙Ú Â Ì‡È- ÔÓ‰ıÓ‰fl˘ Í‡ÚÓ Ô˙‚Ó ÒÂ‰ÒÚ‚Ó Á‡ ÏÓÌÓÚÂ‡-ÔËfl Ì‡ ÂÔËÎÂÔÚË˜ÌË ÔËÒÚ˙ÔË. äÓÏÔÎÂÍÒÌÓ Ì‡·Î˛‰ÂÌËÂËÁ‚˙¯‚‡Ú (2) ‚˙ıÛ 122 ‰Âˆ‡ ‡Á‰ÂÎÂÌË ‚ ÚË „ÛÔË - Á‰‡-‚Ë, ÌÂÎÂÍÛ‚‡ÌË ÂÔËÎÂÔÚËˆË, Ë ÂÔËÎÂÔÚËˆË ÎÂÍÛ‚‡ÌË Ò ‚‡ÎÔÓ-‡Ú, Í‡·‡Ï‡ÁÂÔËÌ, ÙÂÌÓ·‡·ËÚ‡Î, Í‡ÚÓ ÒÂ ÛÒÚ‡ÌÓ‚fl‚‡, ˜ÂÏÓÌÓÚÂ‡ÔËflÚ‡ Ò ‚‡ÎÔÓ‡Ú ÓÒË„Ûfl‚‡ Ì‡È–‰Ó·˙ ÓÍÒË‰‡ÚË-‚ÂÌ/ ‡ÌÚËÓÍÒË‰‡ÚË‚ÂÌ ·‡Î‡ÌÒ. Ç ‰Û„Ó ÔÓÛ˜‚‡ÌÂ (6) ÌÂ Â Ú‡-Í‡ Í‡ÚÂ„ÓË˜ÂÌ Ò ÍÓÈ ÏÂ‰ËÍ‡ÏÂÌÚ Úfl·‚‡ ‰‡ ÒÂ ÒÚ‡ÚË‡ÔÓÚË‚ÓÂÔËÎÂÔÚË˜Ì‡Ú‡ ÏÓÌÓÚÂ‡ÔËfl. ë˙Ó·˘‡‚‡ Á‡ ·ÎËÁÍËÂÁÛÎÚ‡ÚË Ì‡ Í‡·‡Ï‡ÁÂÔËÌ Ë ‚‡ÎÔÓ‡Ú. èËÚÂÒÌËÚÂÎÌËÙ‡ÍÚË ËÁÎ‡„‡ (4). íÓÁË ÍÓÎÂÍÚË‚ Ò˙Ó·˘‡‚‡ Á‡ ÚÂÊÍË ÛÒÎÓÊ-ÌÂÌËfl ÔË ‰Âˆ‡ ÎÂÍÛ‚‡ÌË Ò Í‡·‡Ï‡ÁÂÔËÌ- ÍÓÓÌ‡Ì‡ ‡ÚÂÓ-ÒÍÎÂÓÁ‡ Ë ÏËÓÍ‡‰ÂÌ ËÌÙ‡ÍÚ, ıËÔÂıÓÎÂÒÚÂÓÎÂÏËfl, Îfl‚‡‚ÂÌÚËÍÛÎÌ‡ ıËÔÂÚÓÙËfl, ÏÓÁ˙˜ÌË ËÌÙ‡ÍÚË, ÔÂËÙÂÌÓ-Ò˙‰Ó‚Ë Ì‡Û¯ÂÌËfl. åÓÊÂ ‰‡ ÒÂ ÔÂ‰ÔÓÎÓÊË, ˜Â Ú‡ÍË‚‡ ÒÚ‡-ÌË˜ÌË ÂÙÂÍÚË ÒÂ Ó˜‡Í‚‡Ú Ë ÔË ‚˙Á‡ÒÚÌË ·ÓÎÌË Ò ÏÓÁ˙˜ÌËÚÛÏÓË. íÂÁË ·ÓÎÌË ÔÂÚ˙Ôfl‚‡Ú ÂÍ‡ÚË‡ÌÂ ËÎË ÂÁÂÍˆËflÌ‡ ÏÓÁ˙˜Ì‡Ú‡ ÍÓ‡ Ë ÒÎÂ‰ÓÔÂ‡ÚË‚ÌÓ Ò‡ Ò ‚ÎÓ¯ÂÌ‡ ÏÓÁ˙˜Ì‡Í˙‚Ì‡ ˆËÍÛÎ‡ˆËfl Ë ÏÓÁ˙˜ÂÌ ÓÚÓÍ. çÂ ÏÓ„‡Ú ‰‡ ÒÂ ÔÂÌÂ·-Â„Ì‡Ú ÓÔËÒ‡ÌËÚÂ Ì‡·Î˛‰ÂÌËfl. ë˙˘ËflÚ ÍÓÎÂÍÚË‚ ËÁÒÎÂ‰-‚‡Ú ·ÓÎÌË ÎÂÍÛ‚‡ÌË Ò ‚‡ÎÔÓ‡Ú Ë Í‡·‡Ï‡ÁÂÔËÌ Ë ÛÒÚ‡ÌÓ‚fl-‚‡Ú, ̃ Â Í‡ÔËÎflÌ‡Ú‡ ÔÎ˙ÚÌÓÒÚ Ë Í‡ÔËÎflÌËflÚ ‰Ë‡ÏÂÚ˙ ÒÂÂ‰ÛˆË‡Ú, ‡ ‚ËÒÍÓÁËÚÂÚ˙Ú Ì‡ ÔÎ‡ÁÏ‡Ú‡ Ë ‡„Â„‡ˆËflÚ‡ Ì‡ÂËÚÓˆËÚËÚÂ ÒÂ Û‚ÂÎË˜‡‚‡ ÔË ÔËÎÓÊÂÌËÂÚÓ Ë Ì‡ ‰‚‡Ú‡ÏÂ‰ËÍ‡ÏÂÌÚ‡. ê‡Á·Ë‡ ÒÂ ‚ÎËflÌËÂÚÓ Ì‡ ‚ÒÂÍË ÏÂ‰ËÍ‡ÏÂÌÚ ÂÍÓÏÔÎÂÍÒÌÓ ‚˙ıÛ Ó„‡ÌËÁÏ‡. ëÚ‡ÌË˜ÌË ÂÙÂÍÚË ÏÓ„‡Ú ‰‡ÒÂ Ì‡·Î˛‰‡‚‡Ú Ë ÔË ÔÓ-Í‡ÚÍÓÚ‡ÈÌÓ ÔËÂÏ‡ÌÂ Ì‡ ÏÂ‰ËÍ‡-ÏÂÌÚ‡, ÌÓ ‚ ÒÂËflÚ‡ Ò Ì‡¯ËÚÂ Ô‡ˆËÂÌÚË ÌÂ Ì‡·Î˛‰‡‚‡ıÏÂÚ‡ÍË‚‡. íÓ‚‡ ÒÂ ÓÚÌ‡Òfl Ë Á‡ ·ÓÎÌËÚÂ ÔÂÚ˙ÔÂÎË ÚÂÊÍË ËÌ-

ÚÂ‚ÂÌˆËË Í‡ÚÓ ÎÓ·ÂÍÚÓÏËË, Á‡ ÓÚÒÚ‡Ìfl‚‡ÌÂ Ì‡ ÔÓÎ˛ÒÌËÚÛÏÓË. çÂ ÒÏÂ ËÏ‡ÎË ÒÎÛ˜‡Ë Ì‡ ‚ÂÌÓÁÂÌ ËÎË ‡ÚÂË‡ÎÂÌÚÓÏ·ÂÏ·ÓÎËÁ˙Ï, ÌËÚÓ ‡Á‰‚ËÊ‚‡ÌÂ Ì‡ ˜ÂÌÓ‰Ó·ÌË ËÎË·˙·Â˜ÌË ÔÓÍ‡Á‡ÚÂÎË. èÓÛ˜ÂÌÓ Â (1) ‚ÎËflÌËÂÚÓ Ì‡ ‚‡ÎÔÓ‡-Ú‡ Ë Í‡·‡Ï‡ÁÂÔËÌ‡ ‚˙ıÛ ıÓÏÓˆËÒÚÂËÌÓ‚‡Ú‡ Ó·ÏflÌ‡ Á‡ÔÂÚ ÏÂÒÂ˜ÂÌ ÔÂËÓ‰ Ì‡ Ì‡·Î˛‰ÂÌËÂ. ëÂÛÏÌÓÚÓ ÌË‚Ó Ì‡ ıÓ-ÏÓˆËÒÚÂËÌ‡ Ì‡‡ÒÚ‚‡ ÔË ‰‚ÂÚÂ „ÛÔË, ‡ Ó·ÏflÌ‡Ú‡ Ì‡ ÙÓ-ÎËÂ‚‡ ÍËÒÂÎËÌ‡ Ë ‚ËÚ Ç12 ÒÂ ‚ÎÓ¯‡‚‡ ‚ „ÛÔ‡Ú‡ ÎÂÍÛ‚‡Ì‡ ÒÍ‡·‡Ï‡ÁÂÔËÌ. ÑÛ„ ÍÓÎÂÍÚË‚ (10) ÌÂ ÔÂÔÓ˙˜‚‡ ÔÓÙËÎ‡Í-ÚË˜ÌÓ ÎÂ˜ÂÌËÂ ÔË ·ÓÎÌË Ò ÏÓÁ˙˜ÌË ÚÛÏÓË, ‡ÍÓ ÌÂ Ò‡ ËÏ‡ÎËÂÔËÎÂÔÚË˜ÌË ÔËÒÚ˙ÔË. Ä‚ÚÓËÚÂ Ò˜ËÚ‡Ú Á‡ ÔÓÚË‚ÓÔÓ-Í‡Á‡ÌÓ ÔËÎÓÊÂÌËÂÚÓ Ì‡ ÂÌÁËÏ-ËÌ‰ÛˆË‡˘Ë ÔÓÚË‚ÓÂÔËÎÂÔ-ÚË˜ÌË ÏÂ‰ËÍ‡ÏÂÌÚË ÔÓ‡‰Ë ‚Á‡ËÏÓ‰ÂÈÒ‚ËÂÚÓ ËÏ Ò ıËÏËÓ-ÚÂ‡ÔÂ‚ÚËˆËÚÂ. èË ÌÛÊ‰‡ Ì‡ ·‡Á‡Ú‡ Ì‡ „ÓÎflÏ ÍÎËÌË˜ÂÌÓÔËÚ ‡‚ÚÓËÚÂ ÔÂÔÓ˙˜‚‡Ú ÏÓÌÓÚÂ‡ÔËfl Ò ‚‡ÎÔÓ‡Ú, Ë‰ÓÔ˙ÎÌËÚÂÎÌÓ ‡ÍÓ ÔËÒÚ˙ÔËÚÂ ÔÓ‰˙ÎÊ‡‚‡Ú- ÎÂ‚ÂÚË‡ˆÂ-Ú‡Ï. êËÒÍ˙Ú ÓÚ ÍÓ„ÌËÚË‚ÌË Ì‡Û¯ÂÌËfl ÓÚ ÛÔÓÚÂ·‡ Ì‡ÔÓÚË‚ÓÂÔËÎÂÔÚË˜ÌË ÏÂ‰ËÍ‡ÏÂÌÚË Ì‡‡ÒÚ‚‡ ÒÎÂ‰ ÓÔÂ‡-ÚË‚Ì‡ Ì‡ÏÂÒ‡ Ë Â‚ÂÌÚÛ‡ÎÌÓ Î˙˜ÂÎÂ˜ÂÌËÂ, Á‡ÚÓ‚‡ ‡‚ÚÓËÚÂÔÂÔÓ˙˜‚‡Ú ‚ÌËÏ‡ÚÂÎÂÌ ÔÓ‰·Ó Ì‡ ÏÂ‰ËÍ‡ÏÂÌÚ, ‰ÓÁ‡ ËÔÓ‰˙ÎÊËÚÂÎÌÓÒÚ Ì‡ ÔËÎÓÊÂÌËÂ. é·ÂÍÚ Ì‡ Ì‡¯ÂÚÓ ËÁÒÎÂ‰-‚‡ÌÂ Ò‡ Ô˙‚ËÚÂ ÒÎÂ‰ÓÔÂ‡ÚË‚ÌË ‰ÌË. ë˜ËÚ‡ÏÂ, ˜Â ËÁ·‡ÌË-flÚ ÏÂ‰ËÍ‡ÏÂÌÚ Á‡ ÔÓÚË‚ÓÂÔËÎÂÔÚË˜Ì‡ ÔÓÙËÎ‡ÍÚËÍ‡Úfl·‚‡ ‰‡ Â Â‰ËÌ, ‰‡ ÏÓÊÂ ‰‡ ·˙‰Â ÔËÎ‡„‡Ì ÔË ÌÛÊ‰‡ÔÓ‰˙ÎÊËÚÂÎÌÓ ‚ÂÏÂ, ·ÂÁ ÌÂÊÂÎ‡ÌË ‚Á‡ËÏÓ‰ÂÈÒÚ‚Ëfl Ò ‰Û-„Ë ÏÂ‰ËÍ‡ÏÂÌÚË. (7) Ó·Ò˙Ê‰‡ ÔÓÚË‚ÓÂ˜Ë‚ËÚÂ ÂÁÛÎ‡ÚËÓÚ ‡ÁÎË˜ÌË ËÁÒÎÂ‰‚‡ÌËfl Í‡ÚÓ Ô‡‚Ë ÌflÍÓÎÍÓ ËÁ‚Ó‰‡:

1 èÓÚË‚ÓÂÔËÎÂÔÚË˜Ì‡ ÔÓÙËÎ‡ÍÚËÍ‡ ÔË ÌÂ‚ÓıËÛ-„Ë˜ÌÓ ·ÓÎÌË Úfl·‚‡ ‰‡ ÒÂ ÔËÎ‡„‡ Á‡ Í‡Ú˙Í ÔÂËÓ‰ – 7 ‰ÌË,ÌÓ ÚÓÁË ÒÓÍ ÌÂ Â ‰ÓÒÚ‡Ú˙˜ÂÌ Á‡ ÔÓ-Í˙ÒÌ‡ ÔÂ‚ÂÌˆËfl Ì‡ ÂÔË-ÎÂÔÚË˜ÌË ÔËÒÚ˙ÔË ÔË ÏÓÁ˙˜ÌË ÌÂÓÔÎ‡ÁÏË.

2 àÁÔÓÎÁ‚‡ÌÂÚÓ Ì‡ ÙÂÌËÚÓËÌ, Í‡·‡Ï‡ÁÂÔËÌ, ÙÂÌÓ·‡·Ë-Ú‡Î ÔË ·ÓÎÌË ÔÓ‚ÂÊ‰‡˘Ë Î˙˜ÂÎÂ˜ÂÌËÂ ÏÓÊÂ ‰‡ ‰Ó‚Â‰Â ‰ÓÚÂÊÍË, ‰ÓË Ù‡Ú‡ÎÌË ÍÓÊÌË ‡ÎÂ„Ë˜ÌË Â‡ÍˆËË. ë˙˘ËÚÂÏÂ‰ËÍ‡ÏÂÌÚË Û‚ÂÎË˜‡‚‡Ú ÍÎË˙ÌÒ‡, Ì‡Ï‡Îfl‚‡Ú ÍÎËÌË˜ÌËflÂÙÂÍÚ Ì‡ ÍÓÚËÍÓÒÚÂÓË‰ËÚÂ Ë ıËÏËÓÚÂ‡ÔÂ‚ÚËˆËÚÂ,Ú˙È Í‡ÚÓ ÚÂ Ò˙˘Ó ÒÂ ÏÂÚ‡·ÓÎËÁË‡Ú ÓÚ ˆËÚÓıÓÏ ê450.èË Ó·˘‡ ÒÚ‡ÚËÒÚËÍ‡ Ì‡ Á‡·ÓÎÂ‚‡ÂÏÓÒÚÚ‡ ÓÚ ÏÓÁ˙˜ÌËÌÂÓÔÎ‡ÁÏË ‚ ëÄô ÒÂ ÛÒÚ‡ÌÓ‚fl‚‡Ú 200 000 ÌÓ‚Ó‰Ë‡„ÌÓÒÚË-ˆË‡ÌË ·ÓÎÌË (9). éÚ Úflı 20 - 40 % Ò‡ Ò˙Ò ÂÔË ÒËÏÔÚÓÏ‡-ÚËÍ‡. ëÎÂ‰ ÏÛÎÚËˆÂÌÚË˜ÂÌ, ÒÚ‡ÚËÒÚË˜ÂÒÍË ‡Ì‡ÎËÁ ËÔÂ„ÎÂ‰ Ì‡ ÎËÚÂ‡ÚÛ‡Ú‡, ÔÂÔÓ˙˜‚‡ ‰‡ ÌÂ ÒÂ ÔËÎ‡„‡ ÔÓ-ÙËÎ‡ÍÚË˜ÌÓ ÎÂ˜ÂÌËÂ Ò ‡ÌÚËÍÓÌ‚ÛÎÒ‡ÌÚË ÔË ·ÓÎÌË Ò Ô˙-‚Ë˜ÌË Ë ‚ÚÓË˜ÌË ÏÓÁ˙˜ÌË ÚÛÏÓË, ÍÓËÚÓ ÌÂ Ò‡ ËÏ‡ÎË ÂÔËÔËÒÚ˙ÔË, Ú˙È Í‡ÚÓ ËÒÍ˙Ú ÓÚ ÒÚ‡ÌË˜ÌË ÂÙÂÍÚË Â ÔÓ-„ÓÎflÏ. ç‡ Ò˙˘ÓÚÓ ÒÚ‡ÌÓ‚Ë˘Â Â Ë (11). Ä‚ÚÓËÚÂ ‰Ó·‡-‚flÚ, ˜Â ÌÂ‚ÓıËÛÁËÚÂ ‚ ëÄô, ‚˙ÔÂÍË Ì‡Ô‡‚ÂÌËÚÂ ‡Ì‡-ÎËÁË ÔÓ‰˙ÎÊ‡‚‡Ú ‰‡ ÔËÎ‡„‡Ú ‡ÌÌ‡ ÒÎÂ‰ÓÔÂ‡ÚË‚Ì‡ ÔÓ-ÙËÎ‡ÍÚËÍ‡ Ì‡ ·ÓÎÌË Ò ÏÓÁ˙˜ÌË ÚÛÏÓË. èÓ-‡ÁÎË˜Ì‡ „ÎÂ‰Ì‡ÚÓ˜Í‡ ÔÂ‰ÒÚ‡‚fl (9). ëÔÓÂ‰ ÚÓÁË ÍÓÎÂÍÚË‚, ËÒÍ˙Ú ÓÚÂÔËÎÂÔÚË˜ÌË ÔËÒÚ˙ÔË Â ÔÓ-„ÓÎflÏ ÔË ‡ÁÔÓÎÓÊÂÌËÂ Ì‡ ÚÛ-ÏÓ‡ ‚ ˆÂÌÚ‡ÎÌ‡ ÁÓÌ‡, ÔË ÌËÒÍ‡ ÒÚÂÔÂÌ Ì‡ Ï‡ÎË„ÌËÚÂÚËÎË ÏÌÓÊÂÒÚ‚ÂÌÓÒÚ. èË ÎËÔÒ‡ Ì‡ ÍÎËÌË˜ÌÓ ÔÓfl‚ÂÌË ÂÔË-ÎÂÔÚË˜ÌË ÔËÒÚ˙ÔË ÌÂ Â ÛÏÂÒÚÌ‡ ÔÓÙËÎ‡ÍÚËÍ‡, ÔÓ‡‰Ë ‚Á‡-ËÏÓ‰ÂÈÒÚ‚ËflÚ‡ Ì‡ ÔÓÚË‚ÓÂÔËÎÂÔÚË˜ÌËÚÂ ÏÂ‰ËÍ‡ÏÂÌÚË ÒıËÏËÓÚÂ‡ÔÂ‚ÚËˆË Ë ÍÓÚËÍÓÒÚÂÓË‰Ë. Ç ‰Û„ËÚÂ ÒÎÛ˜‡Ë ÂÔÓ- ‰Ó·Â ‰‡ ÒÂ ËÁÔÓÎÁ‚‡ ÏÂ‰ËÍ‡ÏÂÌÚ, ˜ËÈÚÓ ÏÂÚ‡·ÓÎËÁ˙ÏÌÂ Â Ò‚˙Á‡Ì Ò ˆËÚÓıÓÏ ê450 ÂÌÁËÏÂÌ ÍÓÏÔÎÂÍÒ. çËÂ Ò˜ËÚ‡-ÏÂ, ˜Â ‡ÌÌ‡Ú‡ ÔÓÒÚÓÔÂ‡ÚË‚Ì‡ ÔÓÙËÎ‡ÍÚËÍ‡ Ò ÔÓÚË‚ÓÂ-ÔËÎÂÔÚË˜ÌË ÏÂ‰ËÍ‡ÏÂÌÚË ÔË ·ÓÎÌË ÓÔÂË‡ÌË Á‡ ÏÓÁ˙˜ÌËÚÛÏÓË Â Á‡‰ Î̇ÊËÚÂÎÌ‡ – ÌÂÁ‡‚ËÒËÏÓ ÓÚ ‚Ë‰‡ Ì‡ ÚÛÏÓ‡,Ì‡ÎË˜ËÂÚÓ ËÎË ÌÂ Ì‡ ÔÂ‰ÓÔÂ‡ÚË‚ÌË ÂÔËÎÂÔÚË˜ÌË ÔËÒÚ˙-ÔË. èÂ‰ÎÓÊÂÌËfl ÔÂËÓ‰ ÓÚ 7 ‰ÌË Á‡ ÔÓÙËÎ‡ÍÚËÍ‡ ‚ ÒÎÂ‰Ó-ÔÂ‡ÚË‚ÌËfl ÔÂËÓ‰ Â ÔÂÍ‡ÎÂÌÓ Í‡Ú˙Í. Ç ‡ÏÍËÚÂ Ì‡ 10-15‰ÌË ‚ÒÂ Ó˘Â Â Ì‡ÎËˆÂ ÔÂËÙÓÍ‡ÎÂÌ ÓÚÓÍ, ÔÓ‰ Î̇Ê‡‚‡ ÂÁÓ·-ˆËflÚ‡ Ì‡ Í˙‚Ú‡ ‚ ÓÔÂ‡ÚË‚ÌÓÚÓ ÔÓÎÂ, Í‡ÍÚÓ Ë ÓÚ ÒÛ·‡‡ı-ÌÓË‰‡ÎÌÓÚÓ ÔÓÚ‡ÌÒÚ‚Ó. ÄÍÚË‚Ë‡ ÒÂ Ï‡ÍÓÙ‡„Â‡ÎÌ‡Ú‡


ÒËÒÚÂÏ‡ Á‡ ÓÚÒÚ‡Ìfl‚‡ÌÂ Ì‡ ÌÂÍÓÚË˜ÌË Ë ‡ÔÓÔÚÓÚË˜ÌËÍÎÂÚÍË. íÓÁË ÔÓˆÂÒ ÔÓ‰ Î̇Ê‡‚‡ Ò ÏÂÒÂˆË. íÓ˜ÌÓ ‚ ÚÓÁË ÔÂ-ËÓ‰ ˜‡ÒÚ ÓÚ ·ÓÎÌËÚÂ ÔÓ‚ÂÊ‰‡Ú Î˙˜ÂÎÂ˜ÂÌËÂ, ÍÓÂÚÓ Ò˙˘ÓÚ‡‚ÏË‡ ÏÓÁ˙Í‡. çÂ ·Ë ·ËÎÓ Û‰‡˜ÌÓ ‡ÌÌÓÚÓ ÔÓÙËÎ‡ÍÚË˜-ÌÓ ÎÂ˜ÂÌËÂ ‰‡ ÒÂ ÒÔË‡ Ì‡ ÒÂ‰ÏËfl ‰ÂÌ, ‡ ‚ ÔÓ-Í˙ÒÂÌ ÂÚ‡Ô ÔËÂ„ËÒÚË‡Ì ÂÔËÎÂÔÚË˜ÂÌ ÔËÒÚ˙Ô ‰‡ ÒÂ Á‡ÔÓ˜‚‡ ÓÚÌÓ‚Ó. ÇÌ‡¯‡Ú‡ ÒÂËfl ÌÂ Ò‡ Ì‡·Î˛‰‡‚‡ÌË ÍÎËÌË˜ÌÓ ÔÓfl‚ÂÌË ÂÔËÎÂÔ-ÚË˜ÌË ÔËÒÚ˙ÔË Ë ÒÂ‰ ·ÓÎÌËÚÂ, ÍÓËÚÓ ÔÂ‰ÓÔÂ‡ÚË‚ÌÓ Ò‡ËÏ‡ÎË Ú‡ÍË‚‡. Ñ‡ÌÌËÚÂ ÓÚ ÎËÚÂ‡ÚÛ‡Ú‡, Í‡ÍÚÓ Ë Ì‡¯Ë-ÚÂ Ì‡·Î˛‰ÂÌËfl, ÌË ‰‡‚‡Ú ÓÒÌÓ‚‡ÌËÂ ‰‡ ÔËÂÏÂÏ, ˜Â ËÁ·‡ÌËflÏÂ‰ËÍ‡ÏÂÌÚ ‚ Ú‡ÁË ‰ÓÁ‡ Â ÔÓ‰ıÓ‰fl˘ Ë ‰ÓÒÚ‡Ú˙˜ÂÌ ‰‡ „Ë ÍÛ-ÔË‡.


ê‡ÌÌ‡Ú‡ ÔÓÒÚÓÔÂ‡ÚË‚Ì‡Ú‡ ÔÓÙËÎ‡ÍÚËÍ‡ Ò Depakinechrono Ì‡ ÂÔËÎÂÔÚË˜ÌË ÔËÒÚ˙ÔË ÔË ·ÓÎÌË Ò ÏÓÁ˙˜ÌË ÚÛÏÓ-Ë Â Ì‡‰ÂÊ‰Ì‡ Ë ·ÂÁ ÌÂÊÂÎ‡ÌË ÂÙÂÍÚË Ì‡ ÏÂ‰ËÍ‡ÏÂÌÚ‡.

ãàíÖêÄíìêÄ1. Attilakos A, Papakonstantinou E, Schulpis K, Voudris K, Katsarou E,

Mastroyianni S, Garoufi A. Early effect of sodium valproate and carba-mazepine monotherapy on homocysteine metabolism in children with epilep-sy. Epilepsy Res. 2006 Oct;71(2-3):229-32.

2. Aycicek A, Iscan A. The effects of carbamazepine, valproic acid and pheno-barbital on the oxidative and antioxidative balance in epileptic children. EurNeurol. 2007;57(2):65-9.

3. Ben-Menachem E, Schmitz B, Tomson T, Vajda F. Role of valproate acrossthe ages. Treatment of epilepsy in adults. Acta Neurol Scand Suppl.2006;184:14-27

4. Gerstner T, Woelfing C, Witsch M, Longin E, Bell N, Konig S. Capillarymicroscopy and hemorheology in children during antiepileptic monotherapywith carbamazepine and valproate. : Seizure. 2006 Dec;15(8):606-9.

5. Marson AG, Al-Kharusi AM, Alwaidh M, Appleton R, Baker GA, ChadwickDW, Cramp C, Cockerell OC, Cooper PN, Doughty J, Eaton B, Gamble C,Goulding PJ, Howell SJ, Hughes A, Jackson M, Jacoby A, Kellett M,Lawson GR, Leach JP, Nicolaides P, Roberts R, Shackley P, Shen J, SmithDF, Smith PE, Smith CT, Vanoli A, Williamson PR; SANAD Study group.The SANAD study of effectiveness of valproate, lamotrigine, or topiramatefor generalised and unclassifiable epilepsy: an unblinded randomised con-trolled trial. Lancet. 2007 Mar 24;369(9566):1016-26

6. Marson AG, Williamson PR, Taylor S, Maguire M, Chadwick DW.Efficacyof carbamazepine and valproate as monotherapy for early epilepsy and singleseizures. Neurology. 2006 Nov 28;67(10):1872-5.

7. Michelucci R. Optimizing therapy of seizures in neurosurgery. Neurology.2006 Dec 26;67(12 Suppl 4):S14-8.

8. Sperling MR, Ko J.Seizures and brain tumors. Semin Oncol. 2006Jun;33(3):333-41

9. Stevens GH. Antiepileptic therapy in patients with central nervous systemmalignancies. Curr Neurol Neurosci Rep. 2006 Jul;6(4):311-8

10. Van Breemen MS, Wilms EB, Vecht CJ. Epilepsy in patients with braintumours: epidemiology, mechanisms, and management. Lancet Neurol. 2007May;6(5):421-30.

11. Wen PY, Schiff D, Kesari S, Drappatz J, Gigas DC, Doherty L. Medical man-agement of patients with brain tumors. J Neurooncol. 2006 Dec;80(3):313-32.

Ä‰ÂÒ Á‡ ÍÓÂÒÔÓÌ‰ÂÌˆËflÑ- âÓ‰‡Ì è‡ÌÓ‚ Ñå

äÎËÌËÍ‡ ÔÓ ÌÂ‚ÓıËÛ„ËflåÅÄã ◊ñ‡Ëˆ‡ âÓ‡ÌÌ‡”ìÎ. ÅflÎÓ ÏÓÂ ‹ 81504 ëÓÙËfl


éÚ 18 ‰Ó 20 ÓÍÚÓÏ‚Ë 2007„. ‚ ëÓÙËfl ÒÂ ÔÓ‚Â‰Â ‚ÚÓ-ËflÚ êÂ„ËÓÌ‡ÎÂÌ Ó·Û˜ËÚÂÎÂÌ ÍÛÒ Ì‡ Ö‚ÓÔÂÈÒÍ‡Ú‡ ÙÂ‰Â-‡ˆËfl Ì‡ ÌÂ‚ÓÎÓ„Ë˜ÌËÚÂ ‰ÛÊÂÒÚ‚‡ (ÖîçÑ), Ó„‡ÌËÁË‡ÌÒ˙‚ÏÂÒÚÌÓ Ò Å˙Î„‡ÒÍÓÚÓ ‰ÛÊÂÒÚ‚Ó ÔÓ ÌÂ‚ÓÎÓ„Ëfl, Ö‚-ÓÔÂÈÒÍ‡Ú‡ (ÖÄçé) Ë Å˙Î„‡ÒÍ‡Ú‡ (ÅÄçé) ‡ÒÓˆË‡ˆËfl ÔÓÌÂ‚ÓÓÌÍÓÎÓ„Ëfl. äÛÒ˙Ú ·Â¯Â Ó„‡ÌËÁË‡Ì Ò ÙËÌ‡ÌÒÓ‚‡Ú‡ÔÓ‰ÍÂÔ‡ Ì‡ ‰‚ÂÚÂ Â‚ÓÔÂÈÒÍË Ì‡Û˜ÌË ËÌÒÚËÚÛˆËË Ë Ì‡Ù‡Ï‡ˆÂ‚ÚË˜ÌË ÍÓÏÔ‡ÌËË. Ç ÌÂ„Ó ‚ÁÂı‡ Û˜‡ÒÚËÂ 129 ÌÂ‚-ÓÎÓÁË, ÌÂ‚ÓıËÛÁË Ë Ó·˘ÓÔ‡ÍÚËÍÛ‚‡˘Ë ÎÂÍ‡Ë ÓÚ ˆfl-Î‡Ú‡ ÒÚ‡Ì‡. ãÂÍÚÓË Ì‡ ÍÛÒ‡ ·flı‡ ÌÓÏËÌË‡ÌËÚÂ ÓÚÖîçÑ ‚Ó‰Â˘Ë Â‚ÓÔÂÈÒÍË ÌÂ‚ÓÎÓÁË: ÔÓÙ. Ä. îÂ‰ÂËÍÓ, ÔÓÙ. â. äÂÒÂÎËÌ„, ÔÓÙ. Ñ. Å‡Ò‡Ú,ÔÓÙ. å. ÅËÎfl‰, ÔÓÙ. ë. çÂ‚ÒËÏ‡ÎÓ‚‡, ÔÓÙ. äÎ. Å‡ÒÂÚË,ÔÓÙ. Ç. ÉËÁÓÎ‰, ÔÓÙ. ê. ëÓÙËÂÚË, ÔÓÙ. ê. É‡ÌÚ, ÔÓÙ. å. ÇÂÎÂ. éÚ ·˙Î„‡ÒÍ‡ ÒÚ‡Ì‡ Û˜‡ÒÚ‚‡ı‡ ÔÓÙ. à‚. åËÎ‡ÌÓ‚, ÔÓÙ. Ç. ÅÛÒ‡ÒÍË, ÔÓÙ. í. ï‡‰ÊËÂ‚‡,‰Óˆ. ç. ÑÂÎÂ‚‡, ‰Óˆ. å. åËÎ‡ÌÓ‚‡, ‰- Ä. ä‡ÔÂÎflÌ.

èÓ„‡Ï‡Ú‡ Ì‡ Ô˙‚Ëfl ‰ÂÌ Á‡ÔÓ˜Ì‡ Ò ÎÂÍˆËfl Ì‡ ÔÓÙ.îÂ‰ÂËÍÓ Á‡ „ÂÌÂÚË˜ÌËÚÂ ÎÂ‚ÍÓÂÌˆÂÙ‡ÎÓÔ‡ÚËË, ÔÓÒÎÂ‰‚‡-Ì‡ ÓÚ ÔÓÙ. åËÎ‡ÌÓ‚, ÍÓÈÚÓ ÔÂ‰ÒÚ‡‚Ë Ò˙‚ÂÏÂÌÌËÚÂ ‡Ò-ÔÂÍÚË Ì‡ ÍÎËÌË˜ÌËÚÂ ÒËÌ‰ÓÏË ÔË ÏÌÓÊÂÒÚ‚ÂÌÌ‡ ÒÍÎÂ-ÓÁ‡. èÓÙ. äÂÒÂÎËÌ„ Á‡ÔÓÁÌ‡ ÒÎÛ¯‡ÚÂÎËÚÂ Ò ÔÓ·ÎÂÏËÚÂÌ‡ ÌÂ‚ÓÂı‡·ËÎËÚ‡ˆËflÚ‡ ÔË ÚÓ‚‡ Á‡·ÓÎfl‚‡ÌÂ, ‡ ÔÓÙ. Ñ.Å‡Ò‡Ú – Ò ÏÂ‰ËÍ‡ÏÂÌÚÓÁÌÓÚÓ ÎÂ˜ÂÌËÂ. ëÎÂ‰Ó·Â‰ÌËÚÂ ÒÂ-ÏËÌ‡Ë ‚ÍÎ˛˜‚‡ı‡ ÔÂ‰ÒÚ‡‚flÌÂ Ì‡ ÍÎËÌË˜ÌË ÒÎÛ˜‡Ë Ë‰ÓÔ˙ÎÌËÚÂÎÌË Ó·Ò˙Ê‰‡ÌËfl Ì‡ ÔÂ‰ÒÚ‡‚ÂÌËÚÂ ÚÂÏË.

íÂÏ‡Ú‡ Ì‡ ‚ÚÓËfl ‰ÂÌ - ‡ÁÒÚÓÈÒÚ‚‡ Ì‡ Ò˙Ìfl ·Â¯ÂÔÂ‰ÒÚ‡‚ÂÌ‡ ÓÚ ÔÓÙ. ÅËÎfl‰, ÔÓÙ. çÂ‚ÒËÏ‡ÎÓ‚‡, ÔÓÙ.Å‡ÒÂÚË Ë ‰Óˆ. åËÎ‡ÌÓ‚‡, ÍÓËÚÓ Á‡ÔÓÁÌ‡ı‡ Û˜‡ÒÚÌËˆËÚÂ‚ ÍÛÒ‡ Ò Ì‡ÍÓÎÂÔÒËflÚ‡, Ò˙ÌÌ‡Ú‡ ‡ÔÌÂfl, ÒËÌ‰ÓÏ‡ Ì‡

ÌÂÒÔÓÍÓÈÌËÚÂ Í‡Í‡ Ë ‡ÁÒÚÓÈÒÚ‚‡Ú‡ Ì‡ Ò˙Ìfl ‚ ‰ÂÚÒÍ‡‚˙Á‡ÒÚ. ãÂÍˆËËÚÂ Ë ÒÎÂ‰Ó·Â‰ÌËÚÂ ÒÂÏËÌ‡Ë ·flı‡ ·Ó„‡-ÚÓ ËÎ˛ÒÚË‡ÌË Ò ‚Ë‰ÂÓÔÂÁÂÌÚ‡ˆËË.

èÓ„‡Ï‡Ú‡ Ì‡ ÚÂÚËfl ‰ÂÌ ·Â¯Â Ó„‡ÌËÁË‡Ì‡ ÓÚÖÄçé Ë ÅÄçé. ãÂÍˆËËÚÂ Ì‡ ÔÓÙ. ÉËÁÓÎ‰, ÔÓÙ. ëÓÙË-ÂÚË, ÔÓÙ. É‡ÌÚ, ÔÓÙ. ÇÂÎÂ ·flı‡ ÔÓÒ‚ÂÚÂÌË Ì‡ ÏÓÁ˙˜-ÌËÚÂ ÏÂÚ‡ÒÚ‡ÁË Ë ÚflıÌÓÚÓ ÎÂ˜ÂÌËÂ, Í‡ÍÚÓ Ë Ì‡ ÒÚ‡Ì-‰‡ÚËÚÂ ‚ ÎÂ˜ÂÌËÂÚÓ Ì‡ ÁÎÓÍ‡˜ÂÒÚ‚ÂÌËÚÂ „ÎËÓÏË. á‡¯ËÓÍÓÚÓ ÔÂ‰ÒÚ‡‚flÌÂ Ì‡ ÔÓ·ÎÂÏËÚÂ Ì‡ ÌÂ‚ÓÓÌÍÓÎÓ-„ËflÚ‡ ‰ÓÔËÌÂÒÓı‡ Ë ·˙Î„‡ÒÍËÚÂ ÎÂÍÚÓË: ÔÓÙ. ï‡‰-ÊËÂ‚‡ Ë ÔÓÙ. ÅÛÒ‡ÒÍË Ò ÎÂÍˆËË ‚˙ıÛ ‡‰ËÓÚÂ‡ÔËflÚ‡ÔË ÏÓÁ˙˜ÌË ÏÂÚ‡ÒÚ‡ÁË Ë „ÎËÓÏË Ë Ò˙ÓÚ‚ÂÚÌÓ ‚˙ıÛ ıË-Û„Ë˜ÌÓÚÓ ÎÂ˜ÂÌËÂ Ì‡ „ÎËÓÏËÚÂ Ë ‰Óˆ. ÑÂÎÂ‚‡ Ë ‰- ä‡Ô-ÂÎflÌ - Ò ÔÂ‰ÒÚ‡‚flÌÂ Ì‡ ÍÎËÌË˜ÌË ÒÎÛ˜‡Ë. àÌÚÂÂÒÌ‡Ú‡ÔÓ„‡Ï‡ Á‡‚˙¯Ë Ò Í˙„Î‡ Ï‡Ò‡ Ì‡ ÚÂÏ‡, Ò˙‚ÂÏÂÌÌÓÚÓÒ˙ÒÚÓflÌËÂ Ì‡ ÌÂ‚ÓÓÌÍÓÎÓ„ËflÚ‡ ‚ Å˙Î„‡Ëfl, ÌÂ„Ó‚ÓÚÓ·˙‰Â˘Â, ÒÚ‡ÚÂ„Ëfl Ë ‡Á‚ËÚËÂ.

éÙËˆË‡ÎÌËflÚ ÂÁËÍ Ì‡ ÍÛÒ‡ ·Â¯Â ‡Ì„ÎËÈÒÍË. á‡ Û˜‡ÒÚÌË-ˆËÚÂ ·Â¯Â ÓÒË„ÛÂÌ ÒËÏÛÎÚ‡ÌÂÌ ÔÂ‚Ó‰ Ë ÍÌËÊÍ‡ Ò ÚÂÁËÒË-ÚÂ Ì‡ ÎÂÍˆËËÚÂ. á‡ Úflı ·Â¯Â Ó„‡ÌËÁË‡Ì Ë ËÁÔËÚ Ò ÚÂÒÚ ËÚÂÁË, ÍÓËÚÓ ÔÓÍËı‡ ËÁËÒÍ‚‡ÌËflÚ‡ Ì‡ ÚÂÒÚ‡, ÔÓÎÛ˜Ëı‡ ÒÂ-ÚËÙËÍ‡Ú Á‡ Û˜‡ÒÚËÂ Ë ÛÒÔÂ¯ÌÓ ÔÓÎÓÊÂÌ ËÁÔËÚ Ì‡ ÖîçÑ.

ÉÓÎflÏ‡ ˜‡ÒÚ ÓÚ Û˜‡ÒÚÌËˆËÚÂ ÔËÒ˙ÒÚ‚‡ı‡ Á‡ Ô˙‚ËÔ˙Ú Ì‡ Ó·Û˜ËÚÂÎÂÌ ÍÛÒ Ì‡ ÖîçÑ. íÂ ËÁ‡ÁËı‡ Á‡‰Ó‚ÓÎ-ÒÚ‚ÓÚÓ ÒË ÓÚ ËÁ·Ó‡ Ì‡ ÚÂÏËÚÂ, ‰Ó·Â ÔÓ‰„ÓÚ‚ÂÌËÚÂÎÂÍˆËË Ò ˜Û‰ÂÒÌË ËÎ˛ÒÚ‡ˆËË Ë ËÌÚÂÂÒÌËÚÂ ‰ËÒÍÛÒËË.éˆÂÌÍ‡Ú‡ ËÏ ·Â¯Â Á‡ ÏÌÓ„Ó ÔÓÎÂÁÂÌ Ë ‰Ó·Â Ó„‡ÌËÁË‡ÌÍÛÒ, ÍÓÈÚÓ Â ÔÓÏÓ„Ì‡Î Á‡ Ó·Ó„‡Úfl‚‡ÌÂ Ì‡ ÁÌ‡ÌËflÚ‡ ËÏ ËÌ‡ ÍÎËÌË˜Ì‡Ú‡ ËÏ Ô‡ÍÚËÍ‡. ÇÒË˜ÍË ÚÂ ÔÂÔÓ˙˜‡ı‡ Â-‰Ó‚ÌÓ Ó„‡ÌËÁË‡ÌÂ Ì‡ ÔÓ‰Ó·ÌË ÔÓfl‚Ë ‚ Å˙Î„‡Ëfl.

àÌÙÓÏ‡ˆËËéÅìóàíÖãÖç äìêë çÄ ÖÇêéèÖâëäÄíÄ îÖÑÖêÄñàü

çÄ çÖÇêéãéÉàóçàíÖ ÑêìÜÖëíÇÄ à ëöÇåÖëíçÄ çÄìóçÄëêÖôÄ çÄ ÖÇêéèÖâëäÄíÄ à ÅöãÉÄêëäÄíÄ ÄëéñàÄñàü

èé çÖÇêééçäéãéÉàüà. ÇÂÎ˜Â‚‡

Date post:	12-Mar-2016
Category:	Documents
Upload:	admin-admin
View:	212 times
Download:	0 times

bulneur1_08

Documents